Dermatology & Plastic Surgery Institute Outcomes

Patients who are hospitalized with COVID-19 (COVID-19(+)) are at an increased risk of hospital-acquired sacral pressure injuries (HASPIs), compared with patients who are hospitalized without COVID-19. (COVID-19(-)).¹ Further, COVID-19(+) patients with HASPIs have higher stage ulcerations than COVID-19(-) patients. In a retrospective study of 58,766 hospitalized patients who spent ≥ 5 days at Cleveland Clinic from March 1, 2020─December 31, 2020, 293 developed HASPI. When controlling for Braden risk at admission, age, length of stay, medical comorbidities, intensive care unit admission, and need for ventilation, COVID-19(+) patients had 40% increased odds of developing a HASPI compared with COVID-19(-) patients (P = 0.03) and were more likely to develop a HASPI of severe stage (P = 0.001). Additionally, COVID-19(+) patients with HASPIs had 2.2x odds of a more severe hospitalization course compared with COVID-19(+) patients without HASPIs (P < 0.001). When comparing histologic features of biopsies/debridement tissue related to HASPIs, tissue from COVID-19(+) patients (N = 4) had 3x the number of thromboses in dermal vessels compared with tissue from COVID-19(-) patients (N = 2).

These findings support the observation that the skin may sustain significant damage secondary to COVID-19.²⁻⁴ These injuries may contribute to significant future morbidity, healthcare expenditure, and even mortality in patients who recover from COVID-19.⁵⁻⁶ Histopathologic analysis suggests thrombotic vasculopathy in areas of pressure may play a role in COVID-19-associated HASPI development.

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