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Background: Assessment of severe pressure ulcer dependent on visual observation needs the expertise, therefore objective and simple tool would be useful. We focused on nutritional markers in wound fluid because local nutritional metabolism can be affected by pressure ulcer status such as infection or granulation.
Purpose: We investigated whether the nutritional markers in the wound fluid can reflect the wound status according to the healing phase.
Methods: Patients who aged 60 or over with full-thickness pressure ulcers were included. Two researchers evaluated wound status by clinical signs and categorized into inflammatory/ proliferative phase, and infected/ non-infected wound. Wound fluid was collected by applying film dressing after wound cleansing. After centrifugation, supernatant was used to analyze the concentration of albumin, total protein, glucose and zinc. Serum sample was collected unless data within one week was obtained from medical charts. Hydroxyproline concentration in wound fluid was measured to evaluate the degree of granulation. The protocol was approved by the ethical committee.
Results: Twenty eight patients had 32 pressure ulcers. Albumin level in wound fluid was significantly lower at the inflammatory phase than at the proliferative one (p=0.003), as was the wound fluid/serum ratio of albumin (p=0.020). Both glucose level in wound fluid and wound fluid/serum ratio were negatively correlated with hydroxyproline level at the proliferative phase (ρ=-0.62, -0.73, p=0.001, <0.001, respectively). Zinc level was also correlated positively with hydroxyproline level (ρ=0.53, p=0.010). Wound fluid of infected wounds contained less glucose compared with that of non-infected ones in intraindividual comparison of three cases (6-18 mg/dl for infected wound vs 90-136 mg/dl for non-infected ones).
Discussion/Conclusion: These results suggested that albumin in wound fluid reflect the local inflammation or edema, while glucose reflects the infectious status and collagen synthesis. Nutritional markers in wound fluid are a new potential tool to evaluate pressure ulcer status.
Purpose: We investigated whether the nutritional markers in the wound fluid can reflect the wound status according to the healing phase.
Methods: Patients who aged 60 or over with full-thickness pressure ulcers were included. Two researchers evaluated wound status by clinical signs and categorized into inflammatory/ proliferative phase, and infected/ non-infected wound. Wound fluid was collected by applying film dressing after wound cleansing. After centrifugation, supernatant was used to analyze the concentration of albumin, total protein, glucose and zinc. Serum sample was collected unless data within one week was obtained from medical charts. Hydroxyproline concentration in wound fluid was measured to evaluate the degree of granulation. The protocol was approved by the ethical committee.
Results: Twenty eight patients had 32 pressure ulcers. Albumin level in wound fluid was significantly lower at the inflammatory phase than at the proliferative one (p=0.003), as was the wound fluid/serum ratio of albumin (p=0.020). Both glucose level in wound fluid and wound fluid/serum ratio were negatively correlated with hydroxyproline level at the proliferative phase (ρ=-0.62, -0.73, p=0.001, <0.001, respectively). Zinc level was also correlated positively with hydroxyproline level (ρ=0.53, p=0.010). Wound fluid of infected wounds contained less glucose compared with that of non-infected ones in intraindividual comparison of three cases (6-18 mg/dl for infected wound vs 90-136 mg/dl for non-infected ones).
Discussion/Conclusion: These results suggested that albumin in wound fluid reflect the local inflammation or edema, while glucose reflects the infectious status and collagen synthesis. Nutritional markers in wound fluid are a new potential tool to evaluate pressure ulcer status.