Interpretation of one-year disease risk following pressure injury
The findings of this study reveal a significant association between early-stage pressure injuries and an elevated one-year risk of adverse clinical outcomes among patients with newly diagnosed diabetes. Specifically, patients with pressure injuries demonstrated a 2.90-fold increased risk of developing peripheral arterial occlusive disease (PAOD), a 4.20-fold increased risk of amputation, and a 1.80-fold increased risk of psychiatric disorders compared to those without pressure injuries. These results suggest that pressure injuries may serve as an early surrogate marker of systemic vulnerability, reflecting underlying pathophysiological processes such as impaired microvascular circulation, chronic inflammation, and suboptimal glycemic control. This study highlights the need for a paradigm shift in the clinical and administrative management of pressure injuries among diabetic patients—from reactive treatment of localized skin breakdown to proactive prevention and systemic risk mitigation. Addressing pressure injuries in this context may offer a valuable opportunity to interrupt the progression toward severe vascular, surgical, and neuropsychiatric outcomes, ultimately improving patient quality of life and reducing healthcare resource utilization. Smart healthcare technologies have gained increasing popularity in recent years and are now being widely applied across various medical domains, including cardiology18, cancer screening19, and clinical care20,21,22,23. Among these applications, the integration of health information systems remains a critical priority. Based on the findings of this study, we propose that incorporating automated alerts into electronic health records—specifically for the early detection of pressure injuries—may enable timely identification and facilitate more proactive intervention strategies. Furthermore, the strong association between pressure injuries and psychiatric comorbidities underscores the importance of embedding mental health screening and support services into comprehensive diabetes management frameworks. While most existing studies have focused on pressure injury prevention and detection in intensive care unit (ICU) settings12,13,14,15,16,17,18,19,20,21,22,23,24,25, the present study suggests the value of expanding such approaches to broader diabetic populations in routine care environments.
Implications of increased disease risk after pressure injury
Although many studies have pointed out the association between diabetes mellitus and pressure injuries, a number of studies have investigated the role of diabetes mellitus as a risk factor in the development of pressure injuries13, and diabetes mellitus and surgical factors have not been adequately considered in traditional models of pressure injuries14. Diabetes mellitus is also the most common predictor in applied stress injury risk prediction models15. The association between diabetes and various mental health disorders is becoming clearer16 and there is a correlation between psychiatric disorders and increased mortality17. This study found that diabetic patients with first-degree stress injuries occurring with symptoms of psychiatric disorders had a higher mortality rate than those with PAOD and amputation, and that the longer the duration of the concomitant episode, the lower the chances of survival. In patients with amputation, pressure injuries appear among the factors18, and patients with amputation due to diabetic foot infections have a higher Laboratory Risk Indicator for necrotizing fasciitis (LRINEC) score compared to patients without amputation19. This study found that the risk of amputation increased with time leading to an increase in risk from 2.74 to 4.24. The risk of PAOD did not affect the risk due to the length of time, whereas the Mental risk was found to decrease with the length of time.
This study was based on data obtained from a large-scale electronic health record (EHR) database (TriNetX), which, although comprehensive, is inherently limited by issues such as incomplete or inconsistent data entry, potential coding errors, and diagnostic inaccuracies. As patient data are recorded by a variety of healthcare providers across multiple institutions, variability in documentation practices may introduce selection bias and compromise the accuracy of clinical classifications. Moreover, this study was unable to investigate in depth the etiological mechanisms underlying the development of pressure injuries in patients with diabetes. Nor could it assess the influence of care-related factors such as nurse-to-patient ratios, mobility protocols, or preventive interventions implemented during hospitalization. Future research should integrate both retrospective and prospective approaches and utilize data from acute care settings to capture more detailed clinical, behavioral, and environmental information to better elucidate these associations. In addition, the study cohort was restricted to individuals with a confirmed diagnosis of diabetes mellitus, which may limit the generalizability of the findings to non-diabetic populations. Future investigations should explore whether similar associations exist in other high-risk groups. By addressing these limitations through more granular data collection, standardized clinical assessments, and prospective study designs, future research can build upon the current findings to inform more targeted preventive strategies and improve patient outcomes.