Is Treating Patients With Stage 4 Pressure Ulcers With Vitamins A and C, Zinc, and Arginine Justified?

Kunaal Bafna, MS; Tian Chen, PhD; Richard Simman, MD, FACS, FACCWS


Wounds. 2021;33(3):77-80. 

In This Article

Abstract and Introduction


Introduction: Management of patients with pressure wounds often may entail the administration of vitamins A and C, zinc, and arginine. Supplementing these nutrients as part of a standard wound care protocol may increase the risk for toxicity and unnecessarily increase the cost of health care.

Objective: This study aimed to correlate the nutritional status represented by albumin and prealbumin levels with aforementioned nutrient levels. This understanding would determine whether albumin and prealbumin levels have good predictive value in identifying patients with vitamin deficiencies in this population.

Materials and Methods: Twenty patients aged 18 to 90 years were included, patients had to be admitted in the acute hospital setting with stage 4 pressure ulcers on their sacrum, hips, or heels. Patients already on vitamin supplements were excluded from the study. An odds ratio (OR) was used to assess the association between vitamin deficiency and albumin/prealbumin status. Fisher exact test was performed to test the significance of the association.

Results: The OR of vitamin A deficiency vs albumin deficiency was 0.27, but the association was not significant (95% CI, 0.004–3.68; P = .34). The OR of zinc deficiency vs albumin deficiency was 25.67 (95% CI, 1.2–568.9), and the association was significant (P = .01). The odds of a patient with vitamin C deficiency also having albumin deficiency was 0.62 times greater than that for patients without vitamin C deficiency. Vitamin A deficiency was more likely to be associated with prealbumin deficiency. Zinc deficiency was more likely to be associated with albumin deficiency. While arginine deficiency was more likely to be associated with albumin deficiency, and less likely to be associated with prealbumin deficiency, the results were not statistically significant.

Conclusions: This study showed that routine treatment with vitamins A and C, zinc, and arginine in patients with stage 4 pressure ulcers is not justified.


The lack of adequate treatment for chronic pressure ulcers remains one of the most prominent public health issues to date. Chronic pressure ulcers affect more than 6.5 million people in the United States and are associated with significant morbidity, cost, and suffering for patients.[1] As the prevalence of diabetes, obesity, and cardiovascular disease continues to increase, treatment of chronic pressure ulcers is expected to become increasingly important. Pressure ulcers are defined as skin injuries and/or underlying tissue damage localized over a bony prominence, resulting from pressure force and/or pressure combined with shear.[1] They are often highly burdensome for health care providers as they require weeks to months of complex treatment regimens and a multidisciplinary approach to promote healing.[2] Currently, nutritional management of nearly all patients with pressure wounds includes administration of vitamins A and C, zinc, and arginine because these patients are understood to be vitamin-deficient, although the standard of care is to first measure blood levels of these nutrients before starting patients on supplements. However, there are no high evidence-based studies to support the benefits of administering supplements to these patients. Many of these patients may be otherwise well nourished and will ingest sufficient amounts of these vitamins and essential nutrients as part of their diet. Administration of these supplements to patients with chronic pressure ulcers not only increases the cost of health care but may yield toxic side effects that could otherwise be avoided by not prescribing them unnecessarily. As such, this study aimed to determine whether patients with chronic pressure ulcers are overtreated with vitamins A and C, zinc, and arginine. In addition, the authors aimed to identify correlations between and among albumin, prealbumin, and vitamin levels.