Risk constellation of hospital acquired pressure injuries in patients with a spinal cord injury/ disorder - focus on time since spinal cord injury/ disorder and patients' age.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: The aim of this study was to evaluate how time since spinal cord injury/disorder (SCI/D) and patients' age influence risk constellation for hospital acquired pressure injuries (HAPI) in patients with a SCI/D. SETTING: Acute care and rehabilitation clinic specialized in SCI/D. METHODS: We collected patients' characteristics and 85 risk factors for HAPI development in adults with SCI/D with at least one HAPI during their inpatient stay between August 2018 and December 2019. We analyzed patients' characteristics and HAPI risk factors using descriptive statistics according to time since SCI/D ( < 1 year, 1-15 years, > 15 years) and patients' age (18-35 years, 35-65 years, > 65 years). RESULTS: We identified 182 HAPI in 96 patients. Comparing patients with SCI/D < 1 year with the other groups, autonomic dysreflexia (p < 0.001), abnormal body temperature (p = 0.001), hypertensive episode (p = 0.005), and pneumonia (p < 0.001) occurred more frequently; mean hemoglobin (p < 0.001), albumin (p = 0.002) and vitamin D levels (p = 0.013) were significantly lower, and patients with time since SCI/D < 1 year scored fewer points (10-12) on the Braden Scale (p < 0.001). Comparing groups per patients' age, only the SCIPUS score was higher in patients > 65 years compared to the other two groups (p = 0.002). CONCLUSIONS: Different risk factor constellation seem to be underlying HAPI development with more differences in patients time since SCI/D than patients' age. Awareness of these differences in risk factor constellation depending on time since SCI/D in these patients might lead to different HAPI prevention strategies. SPONSORSHIP: The study team didn't receive any additional sponsorship.

Risk factors for hospital acquired pressure injury in patients with spinal cord injury during first rehabilitation: prospective cohort study.

STUDY DESIGN: Prospective observational cohort study. OBJECTIVES: First, describe pressure injury (PI) and associated risk factors in individuals with spinal cord injury/disorder (SCI/D) during first rehabilitation. Second, evaluate a prediction model for hospital acquired PI (HAPI) development. SETTING: Acute care and rehabilitation clinic specialized in SCI/D. METHODS: Patients ≥18 years of age with SCI/D were included during first rehabilitation between 08/2018 and 12/2019. We performed a systematic literature search to identify risk factors for PI development. Patients were classified according to HAPI developed. Between group differences of patients' characteristics and risk factors were analyzed using descriptive statistics. Logistic predictive models were performed to estimate HAPI development and receiver operator characteristic (ROC) curve was used to test the model. RESULTS: In total, 94 patients were included, 48 (51.1%) developed at least one HAPI and in total 93 were observed, mainly stage I and stage II HAPI according to the European Pressure Ulcer Advisory Panel. We found nine significantly associated risk factors: completeness of SCI/D, pneumonia, sedative medications, autonomic dysreflexia, Braden ≤12 points, SCIPUS ≥9 points, lower admission SCIM and lower admission FIM-cognition, longer length of stay (LOS) (p ≤ 0.0005). In a predictive model, none of the risk factors was associated with HAPI development (AUC = 0.5). CONCLUSION: HAPIs in patients with SCI/D during first rehabilitation are a frequent and complex condition and associated with several risk factors. No predictive model exists but with the identified risk factors of this study, larger studies can create a tailored and flexible HAPI risk prediction model.

Heart rate, heart rate variability and inflammatory biomarkers among young and healthy adults.

BACKGROUND: Heart rate (HR), heart rate variability (HRV), and inflammation are all associated with cardiovascular morbidity and mortality. The aim of this study was to assess potential interrelationships between these parameters in a young and healthy population. METHODS: Healthy individuals aged 25-41 years were included in a prospective population-based study. All participants underwent 24-h electrocardiography using a validated device. The standard deviation of all normal RR intervals (SDNN) was pre-defined as the main HRV outcome variable. High-sensitivity C-reactive protein (hs-CRP), total leukocyte (LC) count and LC subtypes were obtained from venous blood samples. RESULTS: A total of 2064 participants (47% men, 37 years) were included in this analysis. In multivariable linear regression analyses using SDNN as the outcome variable, ß-coefficients (95% confidence intervals) per 1 standard deviation (SD) increase on the log-scale were -0.11 (-0.16; -0.07), p < .0001 for hs-CRP, -0.13 (-0.17; -0.09), p < .0001 for total LC count, -0.12 (-0.16; -0.08), p < .0001 for neutrophils, -0.04 (-0.09; 0.00), p = .05 for lymphocytes and -0.08 (-0.09; -0.02), p = .005 for monocytes. There were positive relationships between resting and ambulatory HR and inflammatory biomarkers, except for lymphocytes. CONCLUSION: In this large cohort of young and healthy adults, inflammatory parameters were strongly associated with increased HR and decreased HRV, suggesting an important interaction between inflammatory pathways and the autonomic nervous system. Key message Inflammatory biomarkers, such as high-sensitivity C-reactive protein and leukocyte cell count with its subtypes were inversely associated with HRV and positively associated with HR. Our findings suggest important interrelationships between inflammatory pathways and the ANS.