Abstract
Background: Bed sores are major burden to hospital care and usually associated with worse prognosis and longer hospital stay. Aims: To evaluate whether simple biochemical inflammatory and nutritional markers would differ between those with bedsores and those without in elderly stroke patients and if there is a distinction between recent bed sore stroke patients and old bed sore stroke patients as regard these biomarkers. Methods: 80 Stroke elderly patients were enrolled and divided into four groups: patients with recent stroke who developed bedsores, patients with recent stroke who did not develop bedsores, patients with old stroke who developed bedsores and patients with old stroke who did not develop bedsores. Nutritional markers (albumin, total protein, magnesium, iron, total iron binding capacity (TIBC), hemoglobin and cholesterol) and inflammatory markers (total leucocyte count, neutrophil to lymphocyte ratio and ferritin) were compared between the four groups. Results: Concerning nutritional markers, albumin (P =< 0.001), Alb/Pr ratio (P =< 0.001), TIBC (P =< 0.001) and cholesterol (P = 0.005) are lower in the acute stroke with bed sore patients versus acute stroke without bed sore. Lower albumin (P =< 0.001) is only found in comparison between chronic stroke with bed sore patients and chronic without bed sore patients. There is a difference between acute stroke with bed sore and chronic stroke with bed sore concerning albumin (P =< 0.001), TIBC (P =< 0.001) and TG (p =< 0.001). Albumin is lower while TG and TIBC are higher in those with acute stroke with bed sores. Regarding inflammatory markers, high neutrophil and ferritin (p =< 0.001) were found in acute stroke with bed sore patients versus acute stroke without bed sore. No difference was found between chronic stroke with bed sore patients and chronic stroke without bed sore patients. Acute stroke with bed sore group has higher TLC, neutrophil, neut/lymph ratio and ferritin (p =< 0.001) than chronic stroke with bed sore group. Conclusions: Acute stroke patients with bed sores are the highest group as regard inflammatory markers due to acute stroke and bed sores together. The presence of bed sore itself causes or is caused by decrease in nutritional markers especially albumin in both, acute and chronic strokes. Other markers are more evident in acute stroke patients who develop bed sore like higher ferritin and neutrophils and lower TIBC, alb/prot ratio and cholesterol. TG differs only in relation to acute stroke but not bed sore. MG was not different between the four groups.
Highlights
A pressure ulcer, known as a pressure sore, decubitus ulcer or bedsore, is defined as an area of localized damage to the skin and underlying tissue caused by pressure, shear, friction and or a combination of these [1]
Other markers are more evident in acute stroke patients who develop bed sore like higher ferritin and neutrophils and lower TIBC, alb/prot ratio and cholesterol
Acute stroke with pressure sores seems to be significantly older in relation to acute stroke without PU (P =< 0.001)
Summary
A pressure ulcer, known as a pressure sore, decubitus ulcer or bedsore, is defined as an area of localized damage to the skin and underlying tissue caused by pressure, shear, friction and or a combination of these [1]. Patients with decreased mobility, limited mental status and increased skin friction and shear may have a higher risk of developing a pressure ulcer [2]. It is well recognized that pressure ulcers represent a significant cause of morbidity and mortality in elderly patients These are likely to develop in patients who are malnourished or have inflammatory conditions. Results: Concerning nutritional markers, albumin (P =< 0.001), Alb/Pr ratio (P =< 0.001), TIBC (P =< 0.001) and cholesterol (P = 0.005) are lower in the acute stroke with bed sore patients versus acute stroke without bed sore. High neutrophil and ferritin (p =< 0.001) were found in acute stroke with bed sore patients versus acute stroke without bed sore. The presence of bed sore itself causes or is caused by decrease in nutritional markers especially albumin in both, acute
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