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Factors predictive of leg-ulcer healing in sickle cell disease: a multicentre, prospective cohort study
P Senet1, C Blas-Chatelain2, P Levy3
1Service de Dermatologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (APHP), 4 Rue de la Chine, Paris CEDEX 20, 75970, France.
Insights
Leg ulcers (LUs) in sickle cell disease (SCD) heal based on ulcer characteristics, not patient biology. Smaller, shorter-duration ulcers (<8 cm², <9 weeks) show better healing outcomes in SCD patients.
Area of Science:
- Hematology
- Vascular Medicine
- Wound Healing
Background:
- Leg ulcers (LUs) represent a severe, chronic complication of sickle cell disease (SCD).
- Limited prospective data exists on factors influencing LU healing and recurrence in SCD patients.
Purpose of the Study:
- To identify clinical and biological factors linked to the complete healing of SCD-related leg ulcers (SCD-LUs).
- To determine factors associated with the recurrence of SCD-LUs during follow-up.
Main Methods:
- A prospective, observational cohort study involving 98 adult SCD patients with LUs lasting ≥2 weeks.
- Data collected from 2009-2015 at two adult SCD referral centers.
- Primary endpoints assessed LU healing at week 24 and recurrence during follow-up.
Main Results:
- At week 24, 47% of LUs healed, and 49% recurred.
- Smaller LU area (<8 cm²) and shorter duration (<9 weeks) were independently associated with healing (P<0.001 and P=0.024, respectively).
- High fetal hemoglobin and low lactate dehydrogenase levels showed associations in univariate but not multivariate analyses for healing or recurrence.
Conclusions:
- Complete healing of SCD-LUs is primarily influenced by the clinical characteristics of the ulcers themselves.
- Ulcer size and duration are key predictors of healing, independent of patient-specific SCD factors.
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.
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