Abnormal thrombosis and neutrophil activation increases the risk of hospital-acquired sacral pressure injuries and morbidity in patients with COVID-19

Abstract

Hospitalized patients have an increased risk of developing hospital-acquired sacral pressure injury (HASPI). However, it is unknown whether SARS-CoV-2 infection affects HASPI development. To explore the role of SARS-CoV-2 infection in HASPI development, we conducted a single institution, multi-hospital, retrospective study of all patients hospitalized for ≥5 days from March 1, 2020 to December 31, 2020. Patient demographics, hospitalization information, ulcer characteristics, and 30-day-related morbidity were collected for all patients with HASPIs, and intact skin was collected from HASPI borders in a patient subset. We determined the incidence, disease course, and short-term morbidity of HASPIs in COVID-19(+) patients, and characterized the skin histopathology and tissue gene signatures associated with HASPIs in COVID-19 disease. COVID-19(+) patients had a 63% increased HASPI incidence rate, HASPIs of more severe ulcer stage (OR 2.0, p<0.001), and HASPIs more likely to require debridement (OR 3.1, p=0.04) compared to COVID-19(-) patients. Furthermore, COVID-19(+) patients with HASPIs had 2.2x odds of a more severe hospitalization course compared to COVID-19(+) patients without HASPIs. HASPI skin histology from COVID-19(+) patients predominantly showed thrombotic vasculopathy, with the number of thrombosed vessels being significantly greater than HASPIs from COVID-19(-) patients. Transcriptional signatures of COVID-19(+) samples were enriched for innate immune responses, thrombosis, and neutrophil activation genes. SARS-CoV-2 viral transcripts were detected in skin tissue of COVID-19(+) patients with severe disease. Overall, our results suggest that immunologic dysregulation secondary to SARS-CoV-2 infection, including neutrophil dysfunction and abnormal thrombosis, may play a pathogenic role in development of HASPIs in patients with severe COVID-19.

Mortality Prediction For COVID-19 Patients Based on Demographic, Typical Laboratory Results, and Clinical Data

“…However, around 28,000 additional COVID-19 mortality have been identified in last 28 days (Dong, Du and Gardner, 2023). Despite continuing efforts to develop vaccines and antivirals that are effective against new SARS-CoV-2 strains, there are additional challenges to be resolved (Herscu et al, 2022) The Neutrophil dysfunction and abnormal thrombosis may have an impact in the pathogenesis of severe COVID-19 and increase the risk of mortality (Narang et al, 2023). Both the leucocyte count and the neutrophil count were important predictors of mortality in both non-elderly and older people patients (Ghobadi et al, 2022).…”