Abnormal thrombosis and neutrophil activation increase hospital-acquired sacral pressure injuries and morbidity in COVID-19 patients
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 increased 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 a COVID-19(+) sample subset were enriched for innate immune responses, thrombosis, and neutrophil activation genes. 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.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Mar 21, 2023
- Source ID
- 10.3389/fimmu.2023.1031336
Entities
People
- Amy S. Nowacki
- András K. Ponti
- Angela H. Wei
- Anthony P. Fernandez
- Christine McDonald
- Eduardo Mireles-cabodevila
- Jatin Narang
- Jeffrey D. Mcbride
- Jessica Johnson
- Joshua Gallop
- Kevin Cooper
- Lynne Kokoczka
- Ryan Musich
- Samreen Jatana
- Sokhna Seck
- Steven Gordon
Organizations
- Clinical and Translational Science Collaborative of Northern Ohio
- Crohn's & Colitis Foundation of America
- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- National Institutes of Health
- United States Department of Defense