First-day Braden score carries more prognostic information than vasoactive dose for pressure injury in ICU patients receiving early vasoactive support

Vasopressor exposure is a reported risk factor for intensive care unit (ICU)-acquired pressure injury, but its prognostic information relative to bedside risk assessment is unknown. In this retrospective single-centre MIMIC-IV cohort of 17,148 adult ICU stays that started vasoactive support within 24 h and remained in the ICU, alive and free of documented injury, at 24 h, 1,833 (10.7%) had a newly documented pressure injury. Peak norepinephrine-equivalent dose, duration of support, hypotension burden and the Braden Scale, measured in the first 24 h, were entered simultaneously in a cause-specific Cox model with death and discharge as competing events. The first-day Braden score had the largest standardized association (hazard ratio 0.77, 95% CI 0.73–0.81 per standard deviation), ahead of hypotension burden (1.10) and peak dose (1.07), and improved discrimination more than peak dose, although modestly. In exploratory analyses, associations were concentrated in the first week, and for lesions severe at first documentation, mostly deep tissue injuries, peak dose was no longer clearly associated after full adjustment including first-day illness severity, whereas duration of support was. In a 48 h landmark subset, whole-stay summarization inflated the Braden association by 58%. First-day bedside assessment carried more prognostic information than vasoactive dose.