P Senet1, C Blas-Chatelain2, P Levy3, E M Manea4, M Peschanski5, T Mirault2, K Stankovic-Stojanovic6, C Debure2, K Debbache4, R Girot6, J-M Bureau2, C Bachmeyer6, C Baldeschi5, F Galacteros4, F Lionnet6, J Gellen-Dautremer7. 1. Service de Dermatologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (APHP), 4 Rue de la Chine, Paris CEDEX 20, 75970, France. 2. Service de Rééducation Vasculaire, Hôpital Corentin-Celton, APHP, 4 Parvis Corentin-Celton, BP 66, Issy-les-Moulineaux CEDEX, 92133, France. 3. Service de Santé Publique, Hôpital Tenon, APHP, Université Pierre et Marie Curie and Institut National de la Santé et de la Recherche Médicale, UMR-S 1136, Paris, France. 4. Unité des Maladies Génétiques du Globule Rouge, Service de Médecine Interne, Centre de Référence de la Drépanocytose, Hôpital Henri-Mondor, APHP and Université Paris-Est Créteil, Créteil, France. 5. Inserm/UEVE UMR 861, I-Stem, AFM, Génopôle Campus 1, Évry, France. 6. Service de Médecine Interne, Centre de Référence de la Drépanocytose, Hôpital Tenon, APHP and Université Pierre et Marie Curie, Paris, France. 7. Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire Poitires, 86021, Poitiers, France.
Abstract
BACKGROUND: Leg ulcers (LUs) are a chronic and severe complication of sickle cell disease (SCD). A prospective study in patients with SCD to identify factors associated with complete healing and recurrence of LUs is lacking. OBJECTIVES: To determine clinical and biological factors associated with SCD-LU complete healing and recurrence. METHODS: This prospective, observational cohort study was conducted at two adult SCD referral-centre sites (2009-2015) and included 98 consecutive patients with at least one LU lasting ≥ 2 weeks. The primary end points compared patients with healed vs. nonhealed LUs at week 24, and patients with vs. without recurrence during follow-up. RESULTS: The median (interquartile range) LU area, duration and follow-up were, respectively, 6·2 cm2 (3-12·8), 9 weeks (4-26) and 65·8 weeks (23·8-122·1). At week 24, LUs were healed in 47% of patients, while 49% of LUs recurred. Univariate analyses identified inclusion LU area < 8 cm2 (82% vs. 35%; P < 0·001), inclusion LU duration < 9 weeks (65% vs. 35%; P = 0·0013) and high median fetal haemoglobin level (P = 0·008) as being significantly associated with complete healing at week 24, and low lactate dehydrogenase level (P = 0·038) as being associated with recurrence. Multivariate analyses retained LU area < 8 cm2 (odds ratio 6·73, 95% confidence interval 2·35-19. 31; P < 0·001) and < 9 weeks' duration (OR 3·19, 95% confidence interval 1·16-8·76; P = 0·024) as being independently associated with healing at week 24. Factors independently associated with recurrence could not be identified. CONCLUSIONS: SCD-LU complete healing is independently associated with the clinical characteristics of LUs rather than the clinical or biological characteristics of SCD.
BACKGROUND:Leg ulcers (LUs) are a chronic and severe complication of sickle cell disease (SCD). A prospective study in patients with SCD to identify factors associated with complete healing and recurrence of LUs is lacking. OBJECTIVES: To determine clinical and biological factors associated with SCD-LU complete healing and recurrence. METHODS: This prospective, observational cohort study was conducted at two adult SCD referral-centre sites (2009-2015) and included 98 consecutive patients with at least one LU lasting ≥ 2 weeks. The primary end points compared patients with healed vs. nonhealed LUs at week 24, and patients with vs. without recurrence during follow-up. RESULTS: The median (interquartile range) LU area, duration and follow-up were, respectively, 6·2 cm2 (3-12·8), 9 weeks (4-26) and 65·8 weeks (23·8-122·1). At week 24, LUs were healed in 47% of patients, while 49% of LUs recurred. Univariate analyses identified inclusion LU area < 8 cm2 (82% vs. 35%; P < 0·001), inclusion LU duration < 9 weeks (65% vs. 35%; P = 0·0013) and high median fetal haemoglobin level (P = 0·008) as being significantly associated with complete healing at week 24, and low lactate dehydrogenase level (P = 0·038) as being associated with recurrence. Multivariate analyses retained LU area < 8 cm2 (odds ratio 6·73, 95% confidence interval 2·35-19. 31; P < 0·001) and < 9 weeks' duration (OR 3·19, 95% confidence interval 1·16-8·76; P = 0·024) as being independently associated with healing at week 24. Factors independently associated with recurrence could not be identified. CONCLUSIONS:SCD-LU complete healing is independently associated with the clinical characteristics of LUs rather than the clinical or biological characteristics of SCD.
Authors: Anna Flattau; Hanna Gordon; Giacomo Vinces; William J Ennis; Caterina P Minniti Journal: Adv Wound Care (New Rochelle) Date: 2018-08-01 Impact factor: 4.730
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