A multi-parameter ultrasound prediction model for nutrition-associated skin failure in hospitalized elderly patients: a prospective cohort study protocol.

BACKGROUND: In malnourished geriatric patients, deficient intake of energy and protein impairs tissue metabolism and microcirculation, significantly contributing to the development of skin failure. This study aims to develop and validate a prediction model for protein-energy malnutrition-associated skin failure among hospitalized elderly patients, facilitating early identification and targeted clinical interventions. METHODS: This prospective, single-center study involves 391 hospitalized patients aged ≥ 65 years. The research is conducted in two stages: identifying independent risk factors and developing a risk prediction model. Bedside ultrasound (US) is utilized as a core assessment tool to quantify nutritional and tissue integrity markers. Specifically, the model incorporates: (a) dermal blood perfusion via power Doppler to evaluate microcirculatory status; (b) subcutaneous tissue thickness to assess structural depletion; and (c) tissue elastography to measure changes in skin stiffness and biomechanical properties. These sonographic data are integrated with clinical and biochemical variables to derive a risk score. Model performance is evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. EXPECTED RESULTS/CONCLUSION: By quantifying early subclinical changes in tissue perfusion and elasticity, the model is intended to identify high-risk patients before overt skin breakdown occurs, providing a critical window for preventive nutritional and nursing care. This prospective study establishes a novel, nutrition-based prediction model for skin failure in geriatric patients. By integrating multi-parametric ultrasound indicators, the model enables a shift from reactive to proactive care. Early identification of high-risk individuals facilitates targeted interventions, ultimately reducing skin-related complications and optimizing the quality of care for the hospitalized elderly population. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2500111057, registered October 24, 2025.