title: Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk.
abstract: BACKGROUND
  Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting.
  
  
  METHODS
  This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30-96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014.
  
  
  RESULTS
  Patients were hospitalized for mean of 24.8±31.4 days (1-310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057-1.229,P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339-6.448,P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693-0.956,P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955-0.997,P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729-8.486,P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092-1.306,P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814-0.951,P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929-0.984,P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672-0.960,P=0.016).
  
  
  CONCLUSIONS
  Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an advanced illness.
authors.affiliation: Department of Nursing and Paramedical Sciences, Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala.
authors.forename: Danuta
authors.initials: D
authors.lastname: Sternal
authors.affiliation: Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wilczyński
authors.affiliation: Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Szewieczek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology*; D007022:Hypotension / Q000453:epidemiology*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010166:Palliative Care / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Waterlow score; advanced illness; blood pressure; hyponatremia; palliative care; pressure ulcers