Diabetes and Pressure Injury in Critical Care Patients ≥65 Years: The Role of Hemoglobin in Patient Outcomes.

Background: Pressure injuries represent a significant healthcare challenge in ICUs, particularly among older adults with diabetes. This study examined the relationship between hemoglobin levels and hospital-acquired pressure injury (HAPrI) development.

Methods: This retrospective cohort study analyzed MIMIC-IV database data from 10,468 ICU patients aged ≥65 years with stays of 2-14 days. Primary outcome was HAPrI development during ICU stay. Clinical and laboratory factors were compared between diabetic and non-diabetic patients.

Results: Among 10,468 patients (mean age 77.56±8.05 years), 366 (3.5%) developed HAPrIs. Diabetes patients (n=1,513, 14.5%) had significantly higher HAPrI rates than non-diabetic patients (6.3% vs 3.0%; P<0.001). Diabetic patients who developed HAPrIs had markedly lower minimum hemoglobin levels than those without HAPrIs (7.94±2.07 vs 10.00±1.73 g/dL; P<0.001). Among diabetic patients with HAPrIs, those developing multiple injuries had lower hemoglobin levels than those with single injuries (7.22±2.06 vs 8.30±2.00 g/dL; P=0.02).

Conclusions: Low hemoglobin levels are strongly associated with HAPrI development in older ICU patients with diabetes, with anemia severity correlating with multiple injury occurrence. Hemoglobin optimization may represent an important targeted prevention strategy for high-risk ICU patients.