title: Estimation of protein loss from wound fluid in older patients with severe pressure ulcers.
abstract: OBJECTIVE
  Protein loss from wound fluid is usually recognized as one of the factors contributing to the deterioration of the nutritional status in older patients with severe pressure ulcers. We quantified the protein loss owing to pressure ulcers and investigated associations with wound-related factors and nutritional status.
  
  
  METHODS
  This cross-sectional study included 25 patients (>or=60 y) from 10 institutions, with full-thickness pressure ulcers. Wound fluid was collected once after accumulating beneath a film dressing. The amount of protein loss per day was estimated by the volume of wound fluid per hour and the total protein concentration in the wound fluid. Wound evaluations and nutritional assessments were performed. Correlations between variables were obtained using Spearman's rank correlation.
  
  
  RESULTS
  The median age of the patients was 79 y (range 61-100), and median body mass index was 19.6 kg/m(2) (12.2-24.9). The median amount of protein loss was 0.2g/d (0.04-2.1), which corresponded to 0.01 g x kg(-1) x d(-1) (<0.01-0.04) and 0.6% (0.1-13.8) of protein intake. Four wounds characterized as infected or surgically debrided lost 1.5-2.1g of protein per day, which was substantially higher than other wounds lost. Protein loss was correlated with wound severity including area, depth, the wound severity score, and infectious markers (all Ps<0.05), but not with body mass index or arm muscle circumference (P>0.05).
  
  
  CONCLUSIONS
  The amount of protein loss could be small and thus may not be related directly to nutritional status, although it increased as the wound became more severe.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. iizaka-tky@umin.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Iizaka
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.forename: Rie
authors.initials: R
authors.lastname: Sekine
authors.forename: Hiroe
authors.initials: H
authors.lastname: Koyanagi
authors.forename: Chizuko
authors.initials: C
authors.lastname: Konya
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000150:complications / Q000503:physiopathology*; D011506:Proteins / Q000502:physiology*; D012720:Severity of Illness Index; D012874:Skin Diseases, Infectious / Q000209:etiology / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D014945:Wound Healing / Q000502:physiology*
chemical_list: D011506:Proteins