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Factors predictive of leg‐ulcer healing in sickle cell disease: a multicentre, prospective cohort study
Author(s) -
Senet P.,
BlasChatelain C.,
Levy P.,
Manea E.M.,
Peschanski M.,
Mirault T.,
StankovicStojanovic K.,
Debure C.,
Debbache K.,
Girot R.,
Bureau J.M.,
Bachmeyer C.,
Baldeschi C.,
Galacteros F.,
Lionnet F.,
GellenDautremer J.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.15241
Subject(s) - medicine , interquartile range , prospective cohort study , confidence interval , odds ratio , surgery , univariate analysis , gastroenterology , cohort , multivariate analysis
Summary Background Leg ulcers ( LU s) 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 LU s 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 LU s 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 cm 2 (3–12·8), 9 weeks (4–26) and 65·8 weeks (23·8–122·1). At week 24, LU s were healed in 47% of patients, while 49% of LU s recurred. Univariate analyses identified inclusion LU area < 8 cm 2 (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 cm 2 (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 LU s rather than the clinical or biological characteristics of SCD .