Correlation of Nutritional Status and Pressure Ulcers Healing in Spinal Cord Injury Subjects

A Non-randomized, Non-controlled Quasi Experimental Study

  • Amit Kumar Bhagat King George's Medical University
  • Rajeshwar Nath Srivastava King George’s Medical University, Lucknow, U.P., India
  • Mukesh Kumar Dwivedi King George's Medical University
  • Sudeepti Ratan Srivastava King George’s Medical University, Lucknow, U.P., India
  • Saloni Raj King George's Medical University
  • Abhijit Chandra King George's Medical University
Keywords: Pressure ulcer, Spinal cord injury, Nutritional biomarkers

Abstract

Objective: This study was done to determine the cause effect relationship between pressure ulcers (PUs) and metabolic alterations in individual having PUs with Spinal Cord Injury (SCI) Methods: 123 SCI subjects with PUs were enrolled in the study. PUs were measured for surface area, exudate, depth and formation of granulation tissue using the pressure ulcers scale for healing tool. The nutritional status of subjects was assessed by measuring serum haemoglobin, albumin and transferrin levels at baseline (week 0), weeks 3 and 6 during follow-up. Results: An inverse correlation of wound size was observed with nutritional status at weeks 3 and 6. There was a significant increase (p < 0.001) in: Haemoglobin (10.7 - 12.4 g/dl), Albumin (2.9 - 4.04 g/dl) and Transferrin (174.1 - 186.9 μg/dl) levels at the time of discharge. The size of PUs was drastically reduced up to 5.4 fold at the time of discharge.  Conclusion: Given the high prevalence of malnutrition among subjects with PUs, performing a routine nutritional screening should result in early identification of residents with the risk of developing PUs. This article gives statistical evidence that healing of PUs is associated with an increase in Hb level and improving metabolic alterations. There seems to be a positive relationship between PU healing cascade and nutritional corrections. In future, this relation may be disclosed with newer intervention.   

References

1. Bhattacharya S, Mishra RK. Pressure ulcers: current understanding and newer modalities of treatment. Indian J Plast Surg 2015;48:4–16.
2. Ikechukwu EC, Ayodiipo IO, Emeka AD, Kayode AJ, Michael NI, Deborah OT. Prevalence and factors associated with healing outcomes of hospital-acquired pressure ulcers among patients with spinal cord injury. J Public Health Epidemiol 2012;4:44–7.
3. Krassioukov A, Eng JJ, Warburton DE, Teasell R. A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil. 2009;90:876–885.
4. Johanne Alhaug, Caryl L Gay, Christine Henriksen, Anners Lerdal. Pressure ulcer is associated with malnutrition as assessed by Nutritional Risk Screening (NRS 2002) in a mixed hospital populationFood Nutr Res. 2017; 61(1): 1324230.
5. Anderson K, Hamm RL. Factors that impair wound healing. J Am Coll Clin Wound Spec 2014;4:84–91.
6. Montalcini T, Moraca M, Ferro Y, Romeo S, Serra S, Raso MG, Rossi F, Sannita WG, Dolce G, Pujia A. Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury. J Transl Med. 2015;13:305.
7. MW Robinson, C Harmon, C O’Farrelly. Liver immunology and its role in inflammation and homeostasis. Cellular & Molecular Immunology 13 (3), 267-276
8. Crispe IN. The liver as a lymphoid organ. Annu Rev Immunol 2009; 27: 147–163.
9. Nemeth E, Baird AW, O'Farrelly C. Microanatomy of the liver immune system. Semin Immunopathol 2009; 31: 333–343.
10. O'Farrelly C, Crispe IN. Prometheus through the looking glass: reflections on the hepatic immune system. Immunol Today 1999; 20: 394–398.
11. Bunn FH. Anemia associata a malattie sistemiche croniche. In: Isselbacher KJ, Adams RD, Braunwald E, Petersdorf RG, Wilson JD (eds). ‘Harrison’s Principi di medicina interna’ 1986, Vol. 2. Piccin: Padova, pp 2109–2112
12. Jarnum S, Lassen NA. Albumin and transferrin metabolism in infections and toxic diseases. Scand J Clin Lab Invest 1961; 13: 357–361.
13. Sehgal PB. Interleukin-6: a regulator of plasma protein gene expression in hepatic and non-hepatic tissues. Mol Biol Med 1990; 7: 117–125.
14. Andus T, Bauer J, Gerok W. Effects of cytokines on the liver. Hepatology 1991; 13: 364–368.
15. Expression of MMP-8 in Pressure Injuries in Spinal cord injury patients managed by negative pressure wound therapy or conventional wound care. Mukesh K Dwivedi, Amit K Bhagat, Rajeshwar N Srivastava, Amita Jain, Kavita Baghel, Saloni Raj. J Wound Ostomy Continence Nurs. 2017; 44(4):343-349.
16. Wians FR, Urban JE, Keffer JH, Kroft SH. Discriminating between iron deficiency anemia and anemia of chronic disease using traditional indices of iron status vs transferrin receptor concentration. Am J Clin Pathol 2001; 116: 446–447
17. Lenche Neloska1 *, Katerina Damevska2 , Andjelka Nikolchev1 , Lidija Pavleska1 , Biljana Petreska-Zovic1 , Milenko Kostov. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility. Maced J Med Sci. 2016 Sep 15; 4(3):423-427.
18. James J. Optimal wound healing: a comprehensive approach through metabolic, anabolic and nutritional interventions. Involuntary weight loss and its effect on the body to heal. WOUNDS. 2002;14(9):4–8.
19. Ortega-Andreu M, Pérez-Chrzanowska H, Figueredo R, Gómez-Barrena E. Blood loss control with two doses of tranexamic acid in a multimodal protocol for total knee arthroplasty. The open orthopaedics journal. 2011;5:44.
20. Schreml S, Szeimies R, Prantl L, Karrer S, Landthaler M, Babilas P. Oxygen in acute and chronic wound healing. British Journal of Dermatology. 2010;163(2):257-68.
21. Löndahl M, Fagher K, Katzman P. What is the role of hyperbaric oxygen in the management of diabetic foot disease? Current diabetes reports. 2011;11(4):285-93
22. Fuoco U1, Scivoletto G, Pace A, Vona VU, Castellano V. Anaemia and serum protein alteration in patients with pressure ulcers. Spinal Cord. 1997 Jan;35(1):58-60.
23. Perkash A, Brown M. Anemia in patients with traumatic spinal cord injury. J Am Paraplegia Soc 1986; 9: 10–152.
24. Corso F. Manuale di patologia clinica, 2nd edn. Masson: Milano, 1986, pp 75–88.
25. Turba RM, Lewis VI, Green D. Decubitus ulcer anemia: response to erythropoietin. Arch Phys Med Rehab 1992; 75: 498–500.
26. Waldman TA, Gordon RS, Rosse W. Studies on the metabolism of serum protein and lipids in patients with analbuminemia. Am J Med 1984; 37: 960–968
27. Mobarhan S. The role of albumin in nutritional support. J Am Coll Nutr 1988; 7: 445–452.
28. Park KH. A retrospective study using the pressure ulcer scale for healing (PUSH) tool to examine factors affecting stage II pressure ulcer healing in a Korean acute care hospital. Ostomy Wound Manage. 2014;60(9):40-51.
29. Fossum M, Ehnfors M, Svensson E, Hansen LM, Ehrenberg A. Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. Int J Med Inform. 2013;82(10):911-21.
30. Posthauer ME, Banks M, Dorner B, Schols JM. The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper. Adv Skin Wound Care. 2015;28(4):175-88.
Published
2018-09-21
Section
Original Article