Nutrition-related status and granulation tissue colour of pressure ulcers evaluated by digital image analysis in older patients.
OBJECTIVE
Granulation tissue colour may be an indicator for nutritional assessment in pressure ulcer (PU) care. This study evaluated the relationship between nutritional status, anaemia and diabetes, and granulation tissue colour of PUs by colour analysis of digital photographs in the clinical setting.


METHODS
The cross-sectional study included 42 older patients with 51 full-thickness PUs from 10 institutions. Patient demographics, wound status, nutritional status and dietary intakes were obtained from medical charts. From a wound image, the granulation red index was processed by computer software and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) was calculated.


RESULTS
Haemoglobin levels were positively associated with %GRI80 levels (p=0.007) in the crude model, but not in the adjusted model (p=0.260). The interaction term between diabetes and protein intake was significantly associated with %GRI80 levels in the adjusted models (p=0.010). At protein intakes of 0.95 g/kg or higher, diabetic wounds exhibited lower %GRI80 levels than non-diabetic wounds (p=0.002). At protein intakes of less than 0.95 g/kg, %GRI80 levels did not differ between diabetic and non-diabetic patients (p=0.247). Protein intakes of 0.95 g/kg or higher were associated with higher %GRI80 levels in non-diabetic patients (p=0.015), but not in diabetic patients (p=0.127).


CONCLUSIONS
Granulation tissue colour, evaluated by the objective and quantitative analysis of digital photography, is related to haemoglobin level, diabetes and dietary intakes in clinical settings.
RN, PHN, PhD, Department of Gerontological Nursing/Wound Care Management, University of Tokyo, Tokyo, Japan.
S
S
Iizaka
RN, MHS, University of Tokyo Hospital, Tokyo, Japan.
H
H
Koyanagi
RN, University of Tokyo Hospital, Tokyo, Japan.
S
S
Sasaki
RD, University of Tokyo Hospital, Tokyo, Japan.
R
R
Sekine
RN, PhD, School of Nursing, Kanazawa Medical University, Ishikawa, Japan.
C
C
Konya
RN, PhD, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan.
J
J
Sugama
RN, PhD, Department of Gerontological Nursing/Wound Care Management, University of Tokyo, Tokyo, Japan.
H
H
Sanada
D000368:Aged; D003116:Color; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D015577:Geriatric Assessment; D006097:Granulation Tissue / Q000502:physiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009752:Nutritional Status; D010781:Photography; D003668:Pressure Ulcer / Q000473:pathology*
D006454:Hemoglobins