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Association Between GLP-1 Use and Short-Term Pressure Ulcer Complications
Sergio A. Segrera
*1, Benjamin Herold
1, John Helm
3, Eric Acosta
1, Kian Daneshi
2, Ernest Chiu
11Department of Plastic Surgery, NYU Langone Health, New York, NY; 2Imperial College London, London, United Kingdom; 3School of Medicine at Stony Brook University, Stony Brook, NY
Background: Glucagon-like peptide-1 receptor agonists (GLP-1s) have recently been associated with improved outcomes in diabetic foot ulcers and venous ulcers, but their association with pressure ulcer outcomes is unknown. Given the distinct pathophysiology of pressure ulcers, the effect of GLP-1s in this population may differ from that observed in other chronic wounds.
Methods: We performed a retrospective cohort study using the TriNetX network. Adults with a diagnosis of pressure ulcer and a documented history of obesity were identified. Exposure was defined as GLP-1 use within 30 days before pressure ulcer diagnosis. GLP-1 users were propensity score matched 1:1 to nonusers for demographics and comorbidities, including obesity-related, vascular, metabolic, neurologic, and frailty-associated covariates. Outcomes at 30 and 90 days included soft-tissue infection/cellulitis, osteomyelitis, and operative wound management, including debridement, surgical wound-bed preparation, and flap procedures.
Results: After matching, 2,141 GLP-1users were compared with 2,141 nonusers. At 30 days, GLP-1 exposure was associated with higher rates of soft-tissue infection/cellulitis (14.25% vs 10.28%; RR 1.39, p<0.0001), osteomyelitis (9.69% vs 7.16%; RR 1.35, p<0.003), and surgery (17.13% vs 11.40%; RR 1.50, p<0.0001). At 90 days, GLP-1 users similarly had higher rates of soft-tissue infection/cellulitis (20.27% vs 15.74%; RR 1.29, p<0.0001), osteomyelitis (14.99% vs 9.29%; RR 1.61, p<0.0001), and surgery (22.47% vs 13.59%; RR 1.65, p<0.0001).
Conclusion: In this propensity-matched TriNetX cohort of patients with pressure ulcers and obesity, recent GLP-1 exposure was associated with worse short-term ulcer-related outcomes. These findings contrast with prior reports in diabetic foot and venous ulcers and suggest that the effect of GLP-1s may differ by wound phenotype. Residual confounding related to frailty, nutrition, and pressure-ulcer severity should be considered, and prospective studies are needed.
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