Meta-analysis and systematic review of the incidence and influencing factors of acute skin failure in ICU patients

Yulin Zheng^1#, Guojing Sui^1#, Huimin Guo¹, Shuangmei Xi¹, Xin Li¹, Chaoqun Wang¹, Lili Zhang^1*, Yanmei Gu^1*

¹Department of Critical Care Medicine, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China.

#YL.Z. and GJ.Sco-first author:. contributed equally to this work.

LL.Z. and YM.G. were co-corresponding authors.

*Correspondence:

Lili Zhang; Email: zhanglilivip@163.com

corresponding author:Yanmei Gu; Email: gymmxt@126.com

Abstract

Objective To systematically evaluate the incidence of acute skin failure (ASF) and influencing factors among patients in the intensive care unit (ICU).

Methods Cohort studies investigating the incidence and determinants of ASF in ICU patients were systematically searched in PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Database, CQVIP, and China Biology Medicine from database inception to August 31, 2025. A meta-analysis was performed using R software.

Results Ten studies involving 2,870 participants were included in the meta-analysis. The pooled incidence of ASF among ICU patients was 38.4% (95% CI: 0.246–0.545). Subgroup analysis indicated significant regional differences in ASF incidence (P<0.001). Meta-regression analysis demonstrated that sample size (β=-0.001), study design (β=1.353), and publication year (β=-1.114) were significantly associated with the effect size. Furthermore, pooled analyses identified sepsis (OR=2.72), renal failure (OR=2.88), use of vasoactive agents (OR=3.31), and use of sedative and analgesic medications (OR=5.15) as significant factors associated with ASF occurrence.

Conclusion ASF is common among ICU patients. Sepsis, renal failure, and the use of vasoactive agents and sedative-analgesic medications may be associated with an increased risk of ASF, providing a basis for early identification and targeted interventions in clinical practice. However, given the substantial heterogeneity among the included studies, these findings require further validation.

Keywords:intensive care unit, acute skin failure, meta-analysis, systematic review, nursing