Prevalência de úlceras por pressão em hospitais do Brasil e associação com o estado nutricional

Abstract

Pressure ulcers represent serious complication, its treatment is expensive and are widely prevalent in the hospital setting. The objective of this study was to determine the prevalence of pressure ulcers (PU) in hospitalized patients in public and private Brazilian hospitals associating them with the nutritional status. Concomitantly, we evaluated other risk factors that might be associated with the development of PU as length of hospital stay, age, immobility, presence of diabetes, cancer, and infection, type of treatment (surgical versus clinical), sex, color, type of institution, the use of nutritional therapy, prognosis, and diagnosis associated specialty. The patients were randomly selected in 13 general hospitals in eight cities. The study involved 473 patients with mean age of 58.4 ± 18.5 years (median 61.0 years) and 53.3% were males. The elderly accounted for 39.9% of the patients. The prevalence of PU was 16.9% and malnutrition of 52.6%, with 22.4% being severely malnourished. Patients over 65 years presented with 28.3 % of PU with Prevalence Ratio (PR) of 2.34 in relation to age less than 65 years (p<0.05). Malnutrition was strongly and significantly associated with the presence of PU (RP 10.46; 95 %CI 3.25 - 33.69) as well as immobilization(RP 74.96; 95% CI 24.18 - 232.36). Malnourished patients also presented with worse stage of PU (p<0.05). Factors such as type of institution, neurological and oncological diagnosis, both grouped, were also associated with the presence of PU, increasing the possibility of development of this lesion in 2.93 and 6.57, respectively (p<0.05). Clinical patients proved to be more infected, more bedridden, more malnourished, had increased complications and length of hospital stay (p<0.05). It has also been observed that length of stay over eight days, patients with clinical diagnoses, use of nutritional therapy and presence of cancer and UP were risk factors for malnutrition. We conclude that the prevalence of patients with recognized pressure ulcers in several Brazilian hospitals, contemplating the five regions of the country is high, as well as the prevalence of malnutrition in this group is alarming.