Impact of Albumin and Amino Acids Replacement Therapy, and Protein-Rich Nutrition on Pressure Ulcer Healing in Malnourished Geriatric and Palliative Patients: A Multidisciplinary Clinical-Laboratory Study

Background: In elderly patients with hypoalbuminaemia, hypoproteinaemia and advanced-stage PUs, chronic inflammation and wound-related protein loss contribute to a self-perpetuating circulus vitiosus, in which protein depletion drives deterioration of tissue repair processes, and in turn, ongoing wound-related catabolism further amplifies systemic protein loss. In this context, reduced serum albumin and total protein represent integrated indicators of systemic inflammatory and catabolic burden associated with delayed wound healing. Aim: This study evaluated the association between individualized nutritional replacement therapy and pressure ulcer healing in malnourished geriatric and palliative patients, using serum albumin, total protein, and PUSH score as longitudinal outcome indicators. Methods: A total of 78 malnourished geriatric and palliative patients with PUs, multiple comorbidities, and poor nutritional status (hypoalbuminemia and/or hypoproteinaemia) receiving patient-tailored nutritional replacement therapy participated in this study. PU assessment using the PUSH version 3.0 tool, as well as measurements of serum albumin and total protein concentrations, were performed on days 0, 30, 60, and 90. Results: Our study demonstrates significant improvement in the serum albumin levels, from 30.2 ± 6.19 at baseline to 42.1 ± 5.59 at day 90. Similarly, total protein concentrations increased from 57.8 ± 9.66 at baseline to 70.6 ± 7.03 at day 90. The improvement in protein status was accompanied by a significant reduction in the PUSH score, from 10.9 ± 2.94 at the first assessment to 2.9 ± 2.63 at the final assessment. Spearman’s rank-order correlation analysis between serum albumin, total protein, and PUSH score demonstrated a significant moderate inverse correlation at later assessment points (day 60 and 90). Conclusions: Individualized and targeted replacement therapy was associated with improved protein status and reduced pressure ulcer severity. Increases in serum albumin and total protein paralleled a marked reduction in PUSH scores, suggesting attenuation of the inflammatory-catabolic circulus vitiosus and a progressive shift toward wound healing in geriatric and palliative patients.