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

Materials and Methods

After approval by an institutional review board, the study included 20 patients, aged 18 to 90 years, who presented to ProMedica Toledo Hospital with stage 4 pressure ulcers of any size on the sacrum, hips, or heels. Patients who were already on vitamin A or C, zinc, and/or arginine supplementation were excluded from the study. Upon admission to the hospital, each patient's blood was drawn to determine nutritional status as per levels of vitamins A and C, zinc, arginine, albumin, and prealbumin. Normal serum values of nutrients were as follows: vitamin A, 20 to 60 mcg/dL; vitamin C, 0.6 to 2.0 mg/dL; zinc, 0.66 to 1.1 μg/mL; and l-arginine, 81 to 113 mmol/L in men and 72 to 88 mmol/L in women. An odds ratio (OR) was used to assess the association between vitamin deficiency and albumin/prealbumin status. The OR is a statistic that quantifies the strength of association between 2 events. In this case, the OR quantifies the strength and direction of the association between each vitamin level with albumin and prealbumin levels (ie, albumin level vs vitamin A level). An OR of greater than 1 indicates a positive association while an OR less than 1 indicates a negative association. Furthermore, a Fisher exact test was performed to test the significance of the association. A P value of less than .05 was considered to be significant, and a 95% CI was constructed to describe the level of confidence that the true association lies within the interval if repeated intervals were constructed.