ASSOCIAÇÃO ENTRE A PREVALÊNCIA DE LESÕES POR PRESSÃO EM PACIENTES CRÍTICOS E SUPLEMENTAÇÃO ALIMENTAR HIPERPROTEICA: ESTUDO TRANVERSAL

Abstract

Pressure injuries (PI) are localized damage to the skin and underlying tissues, caused by sustained pressure of the epidermis against an external surface or by the combination of pressure and shear forces, and may progress to tissue ischemia, necrosis, and, in severe cases, ulcers and amputations. Hospitalized individuals, especially those admitted to intensive care units (ICUs), are particularly susceptible to these injuries due to reduced mobility, nutritional impairment, and compromised health status. This results in prolonged hospital stays, increased costs, and higher morbidity and mortality. Preventive strategies include systematic risk assessment and specific nutritional care. In this context, nutritional supplementation—especially hyperproteic formulations—has been used as an adjuvant nutritional strategy with potential to contribute to the prevention of PI. This cross-sectional study aimed to analyze the association between PI prevalence and hyperproteic nutritional supplementation in critically ill patients. Data were collected between February and October 2025 through the analysis of secondary data from patients receiving nasoenteral tube feeding who were classified as being at high risk for PI development according to the Braden scale, during ICU hospitalization at a public teaching hospital in western Paraná, Brazil. The sample consisted of electronic medical record data from 152 patients, including sociodemographic, clinical, nutritional, and laboratory variables, analyzed using Jamovi software version 2.4.8. The sample had a mean age of 54.2 ± 19.2 years, with a predominance of adults (56%), males (69%), and a PI prevalence of 44%, with a mean time to injury onset of 9 ± 2.9 days. Neurology was the most frequent medical specialty (49%), and traumatic brain injury was the main cause of hospitalization (21%). Regarding comorbidities, hypertension (37%) and diabetes (23%) were the most prevalent. Among patients who received nutritional supplementation, most did not develop PI (71%, n = 54), and those who did (29%, n = 22) had a mean time of 11 ± 2.4 days until injury onset. In contrast, among patients who did not receive supplementation, 59% (n = 45) developed PI during hospitalization, with a mean time of 8 ± 2.7 days until injury development. These descriptive findings were corroborated by adjusted logistic regression analysis, in which non-use of nutritional supplementation was associated with a higher likelihood of developing PI during hospitalization (adjusted OR = 3.45; 95% CI: 1.54–7.75; p = 0.003). Additionally, achievement of nutritional targets was identified as a protective factor associated with a lower likelihood of PI occurrence, independently of supplement use (OR = 0.18; 95% CI: 0.08–0.39; p < 0.001). Longitudinal analysis of laboratory parameters demonstrated progressive improvement in total protein, albumin, and globulin levels throughout hospitalization, predominantly associated with achievement of nutritional targetsIn conclusion, hyperproteic supplementation was associated with a lower occurrence of PI in critically ill patients, reflecting its preferential use in individuals with greater clinical severity and nutritional risk. Moreover, achievement of nutritional targets was consistently associated with a lower prevalence of PI and improvement in laboratory parameters, reinforcing the central role of adequate nutritional support in the care of critically ill patients.