Incidence and Risk Factors of Pressure Injury in Adult ICU Patients: A Prospective Cohort Study

BACKGROUND: Pressure injuries (PIs) remain a persistent challenge in intensive care units (ICUs), causing pain, extended hospital stays and increased costs. Data from India are limited. AIM: To determine the incidence and risk factors for pressure injuries among adult ICU patients in a tertiary care public hospital. STUDY DESIGN: A prospective cohort study was conducted from August to October 2024 in the adult ICUs of a public hospital in central India. All eligible patients were enrolled via total enumeration. Demographic and clinical variables, Braden and APACHE-II scores, and nursing hours per patient-day were collected. New PIs were staged per international guidelines by two nurse-researchers. Data were analysed using descriptive statistics and univariable logistic regression. RESULTS: Of 324 patients, 50 (15.4%; 95% CI: 11.7-19.8) developed 87 new PIs, with an incidence density of 39.1 per 1000 patient-days (95% CI: 31.32-48.23). Most lesions were stage I/II, primarily sacrococcygeal, with a median onset of 4 days. Among the 16 variables examined using univariable analyses, early fever (OR 7.33, 95% CI 3.38-15.88), exclusive non-oral feeding (OR 5.73, 95% CI 2.75-11.95), needing repositioning assistance (OR 4.56, 95% CI 2.06-10.09), medical ICU (OR 3.73, 95% CI 1.87-7.46), vasoactive drug-use (OR 2.31, 95% CI 1.21-4.44), moderate-to-obese body build (OR 2.84, 95% CI 1.23-6.57) and longer ICU stay (OR 1.23/day, 95% CI 1.15-1.31) had the strongest associations with PI. CONCLUSIONS: PIs affect approximately one-in-six ICU patients, with several factors associated with higher odds. Multi-centre studies are needed to examine generalisability and validate ICU-specific risk assessment tools. RELEVANCE TO CLINICAL PRACTICE: High-risk profiles requiring prioritised preventive measures, as early assessment, nutritional optimisation and mobility support include those with prolonged stays, fever, non-oral feeding, medical ICU admission, vasoactive drug-use and non-thin build.