Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Live imaging of baculovirus infection of midgut epithelium cells: a functional assay of per os infectivity factors

The occlusion-derived viruses (ODVs) of baculoviruses are responsible for oral infection of insect hosts, whereas budded viruses (BVs) are responsible for systemic infection within the host. The ODV membrane proteins play crucial roles in mediating virus entry into midgut epithelium cells to initiate infection and are important factors in host-range determination. For Autographa californica multiple nucleopolyhedrovirus (AcMNPV), seven conserved ODV membrane proteins have been shown to be essential for oral infectivity and are called per os infectivity factors (PIFs). Information on the function of the individual PIF proteins in virus entry is limited, partly due to the lack of a good in vitro system for monitoring ODV entry. Here, we constructed a baculovirus with EGFP fused to the nucleocapsid to monitor virus entry into primary midgut epithelium cells ex vivo using confocal fluorescence microscopy. The EGFP-labelled virus showed similar BV virulence and ODV infectivity as WT virus. The ability to bind and enter host cells was then visualized for WT AcMNPV and viruses with mutations in P74 (PIF0), PIF1 or PIF2, showing that P74 is required for ODV binding, whilst PIF1 and PIF2 play important roles in the entry of ODV after binding to midgut cells. This is the first live imaging of ODV entry into midgut cells and complements the genetic and biochemical evidence for the role of PlFs in the oral infection process

Autographa californica Multiple Nucleopolyhedrovirus Ac34 Protein Retains Cellular Actin-Related Protein 2/3 Complex in the Nucleus by Subversion of CRM1-Dependent Nuclear Export

Actin, nucleation-promoting factors (NPFs), and the actin-related protein 2/3 complex (Arp2/3) are key elements of the cellular actin polymerization machinery. With nuclear actin polymerization implicated in ever-expanding biological processes and the discovery of the nuclear import mechanisms of actin and NPFs, determining Arp2/3 nucleo-cytoplasmic shuttling mechanism is important for understanding the function of nuclear actin. A unique feature of alphabaculovirus infection of insect cells is the robust nuclear accumulation of Arp2/3, which induces actin polymerization in the nucleus to assist in virus replication. We found that Ac34, a viral late gene product encoded by the alphabaculovirus Autographa californica multiple nucleopolyhedrovirus (AcMNPV), is involved in Arp2/3 nuclear accumulation during virus infection. Further assays revealed that the subcellular distribution of Arp2/3 under steady-state conditions is controlled by chromosomal maintenance 1 (CRM1)-dependent nuclear export. Upon AcMNPV infection, Ac34 inhibits CRM1 pathway and leads to Arp2/3 retention in the nucleus

Ac34 inhibits CRM1-dependent nuclear export during AcMNPV infection.

<p>(A). Ac34 is sufficient to inhibit CRM1-dependent nuclear export. EGFP-NES was co-expressed with mCherry, mC-Ac34, or mC-Ac34^1-195 in Sf9 cells. In cells co-expressing EGFP-NES and mCherry (row 1 and 2), ethanol (1 μl) or LMB (0.1 μg/ml) was added to the culture medium at 44 hpt. At 48 hpt, all the cells were fixed and subjected to fluorescence microscopy assays. (B). Ac34 is involved in AcMNPV-induced CRM1 pathway dysfunction. A mCherry-NES encoding plasmid was co-transfected with the indicated bacmids in Sf9 cells. At 48 hpt, all the cells were fixed and subjected to fluorescence microscopy assays. The arrow pointed to the bacmid-free cells that showed different spatial pattern of mCherry-NES in comparison with the adjacent vAc34KO^ac34 transfected cells. Densitometry assays were performed simultaneously. The bars represent the means and standard errors of the means for three independent experiments. Each experiment involves the quantification of 30 transfected cells. Scale bar: 20 μm. ***, <i>P<0</i>.<i>001</i>, **, <i>P<0</i>.<i>01</i> *, <i>P<0</i>.<i>05</i>.</p

P40 cytoplasmic distribution is controlled by CRM1-dependent nuclear export.

<p>(A). P40 cytoplasmic distribution is CRM1-dependent. P40-V₅ or P40^Δ360-374-V₅ was expressed in Sf9 cells. At 44 hpt, the carrier solvent ethanol (1 μl) or an equivalent amount of ethanol containing LMB (0.1 μg/ml) were added to the culture medium. At 48 hpt, the cells were fixed and subjected to immunofluorescence microscopy using anti-V₅. Scale bar: 20 μm. (B). CRM1 knockdown assay. Sf9 cells were transfected with ds-crm1^1-1000, ds-crm1^1001-2000, and ds-control (control dsRNA, included in the MEGAscript RNAi kit). At 72 hpt, cells were harvested and subjected to Western blot assay using anti-CRM1. (C). The impact of CRM1 knockdown on P40 subcellular distribution. Sf9 cells were transfected with ds-crm1^1-1000 or ds-control. At 24 hpt, plasmids encoding EGFP-P40 and P40-V₅ were transfected to dsRNA-bearing cells. At 72 hpt, cells were fixed and subjected to fluorescence microscopy assay. Scale bar: 5 μm. Densitometry assays were performed simultaneously. The bars represent the means and standard errors of the means for three independent experiments. Each experiment involves the quantification of 30 transfected cells for each plasmid. ***, <i>P<0</i>.<i>001</i>.</p

The Ac34 C-terminus is essential for P40 nuclear accumulation and actin polymerization in AcMNPV-infected cells.

<p>(A). Ac34 is responsible for P40 nuclear accumulation induced by AcMNPV. Sf9 cells were co-transfected with the indicated bacmids and a P40-V₅ encoding plasmid and analyzed by immunofluorescence microscopy at 48 hpt. EGFP expression indicated the bacmid-transfected cells, and anti-V₅ was used to identify the localization of P40. The arrows pointed to the bacmid-free cells that showed different spatial pattern of P40-V₅ in comparison with the adjacent cells bearing vAc34KO^ac34. (B). Ac34 is involved in nuclear actin polymerization in virus-infected cells. Sf9 cells were transfected with the indicated bacmids. At 48 hpt, the cells were stained with Alexa Fluor 568-phalloidin and Hoechst and analyzed by fluorescence microscopy. For all the cell images, densitometry assays were performed simultaneously. The bars represent the means and standard errors of the means for three independent experiments. Each experiment involves the quantification of 30 transfected cells for each bacmid. Scale bar: 20 μm. ***, <i>P<0</i>.<i>001</i>.</p