Background: Bed sores are major burden to hospital care and usually associated with worse prognosis and longer hospital stay. Nutritional factors can be a contributing factors that influencing the occurrence of pressure ulcers in susceptible patients. Studies showed that calcium and vitamin d signaling were considered a components of epidermal response to wounds through B-catenin transcriptional activity. Many factors are influencing vitamin D production in the skin including age as elderly people are less capable on enough vitamin D production due to thinner skin. Studies showes that active vitamin D upregulate cathelicidin expression in cultured keratinocytes [4-5], cathelicidin is an antimicrobial protein that mediates innate immunity in skin and promoting wound healing and tissue repair and its expression is upregulated during early stages of normal wound healing [6]
Aim: A case control study to study vitamin D level in patients with pressure ulcer in health care facilities
Methods: 80 immobilized elderly patients were enrolled and divided into four groups: acute 40 immobilized patients within 2 weeks post stroke who were subdivided into; group A (20 recent immobilized patients with bedsores) and group B (20 recent immobilized patients without bedsores). 40 chronic immobilized post stroke patients who were subdivide into; group C (20 old immobilized patients with bedsores) and group D (20 old immobilized patients without bedsores).25 hydroxy vitamin D, calcium, and serum phosphate were compared between the four groups.
Results: Vitamin D mean serum level was; (11.4 ng/ml, 12.2ng/ml, 23.4ng/ml and 27.4ng/ml) in groups A, B, C and D correspectively. There was a statistically significant difference for vitamin D level between early post immobilization groups (A and B) and late post immobilization groups (C and D) (P <0.001).Vitamin D was associated with increasing the likelihood of occurrence of early sores (group A) rather than late sores (group C) (odds:0.955 ,p =0.019 ) .Mean serum calcium level was (8.4 mg/dl ,9 mg/dl ,9 mg/dl and 9 mg/dl ) in groups A ,B ,C ,and D correspectively . Calcium level was significantly lower in group A in comparison to other groups (P =0.009) .On Regression model calcium level was not associated with increase in the likelihood of occurrence of early sores (group A) rather than late sores (group C) (ODDS; 0.925, p = 0.0641)
Conclusions: Decreased vitamin D level was associated with increasing the likelihood of occurrence of pressure sores inrecently immobilized stroke patients rather than in old immobilized stroke patients (odds: 0.955, p =0.019).
