{"doi":"10.1101/2022.07.07.22277374","title":"Abnormal thrombosis and neutrophil activation increases the risk of hospital-acquired sacral pressure injuries and morbidity in patients with COVID-19","abstract":"Abstract Hospitalized patients have an increased risk of developing hospital-acquired sacral pressure injury (HASPI). However, it is unknown whether SARS-CoV-2 infection affects HASPI development. To explore the role of SARS-CoV-2 infection in HASPI development, we conducted a single institution, multi-hospital, retrospective study of all patients hospitalized for ≥5 days from March 1, 2020 to December 31, 2020. Patient demographics, hospitalization information, ulcer characteristics, and 30-day-related morbidity were collected for all patients with HASPIs, and intact skin was collected from HASPI borders in a patient subset. We determined the incidence, disease course, and short-term morbidity of HASPIs in COVID-19(+) patients, and characterized the skin histopathology and tissue gene signatures associated with HASPIs in COVID-19 disease. COVID-19(+) patients had a 63% increased HASPI incidence rate, HASPIs of more severe ulcer stage (OR 2.0, p<0.001), and HASPIs more likely to require debridement (OR 3.1, p=0.04) compared to COVID-19(-) patients. Furthermore, COVID-19(+) patients with HASPIs had 2.2x odds of a more severe hospitalization course compared to COVID-19(+) patients without HASPIs. HASPI skin histology from COVID-19(+) patients predominantly showed thrombotic vasculopathy, with the number of thrombosed vessels being significantly greater than HASPIs from COVID-19(-) patients. Transcriptional signatures of COVID-19(+) samples were enriched for innate immune responses, thrombosis, and neutrophil activation genes. SARS-CoV-2 viral transcripts were detected in skin tissue of COVID-19(+) patients with severe disease. Overall, our results suggest that immunologic dysregulation secondary to SARS-CoV-2 infection, including neutrophil dysfunction and abnormal thrombosis, may play a pathogenic role in development of HASPIs in patients with severe COVID-19. One Sentence Summary SARS-CoV-2-induced immune dysregulation contributes to pressure-induced sacral skin ulceration in hospitalized patients with severe COVID-19.","journal":"medRxiv","year":2022,"id":309735,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9476,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":994331,"name":"Samreen Jatana","orcid":"0000-0001-8255-7045","position":1,"is_corresponding":false},{"id":994332,"name":"András K. Ponti","orcid":"0000-0001-8696-5038","position":2,"is_corresponding":false},{"id":866372,"name":"Ryan Musich","orcid":"0000-0003-4272-1036","position":3,"is_corresponding":false},{"id":1004972,"name":"Joshua Gallop","orcid":"0000-0002-1370-6454","position":4,"is_corresponding":false},{"id":542577,"name":"Angela H. Wei","orcid":"0000-0003-0710-4526","position":5,"is_corresponding":false},{"id":1005293,"name":"Sokhna Seck","orcid":null,"position":6,"is_corresponding":false},{"id":348979,"name":"Jessica Johnson","orcid":"0000-0002-4519-3120","position":7,"is_corresponding":false},{"id":1004973,"name":"Lynne Kokoczka","orcid":"0009-0003-2077-6068","position":8,"is_corresponding":false},{"id":336841,"name":"Amy S. Nowacki","orcid":"0000-0002-1216-1448","position":9,"is_corresponding":false},{"id":1004974,"name":"Jeffrey D. McBride","orcid":"0000-0002-2167-9054","position":10,"is_corresponding":false},{"id":1004975,"name":"Eduardo Mireles‐Cabodevila","orcid":"0000-0002-7822-8529","position":11,"is_corresponding":false},{"id":1005294,"name":"Steven Gordon","orcid":null,"position":12,"is_corresponding":false},{"id":441928,"name":"Kevin D. Cooper","orcid":"0000-0002-1986-3602","position":13,"is_corresponding":false},{"id":699630,"name":"Anthony P. Fernandez","orcid":"0000-0003-4490-8427","position":14,"is_corresponding":false},{"id":302610,"name":"Christine McDonald","orcid":"0000-0002-6745-9487","position":15,"is_corresponding":false},{"id":776167,"name":"Jatin Narang","orcid":"0000-0002-8374-6582","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-19T00:33:15.860993Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}