Leg ulcers in sickle-cell disease: factors predictive of healing A multicenter, prospective, cohort study

Summary

Background

Leg ulcers (LUs) are a chronic and severe complication of sickle-cell disease (SCD). A prospective study identifying SCD patients' factors associated with LU complete healing and recurrence is lacking.

Objectives

To determine clinical and biological factors associated with SCD-LU complete healing and recurrence.

Methods

This prospective, observational cohort study conducted at two Adult SCD Referral Center sites (2009–2015), included 98 consecutive patients with ≥ 1 LU(s) lasting ≥ 2 weeks. The primary endpoints compared patients with healed vs. non-healed LUs at week 24 (W24) and patients with vs. without recurrence during follow-up.

Results

Median LU area, duration and follow-up were, respectively, 6·2 cm² [interquartile range 3–12·8], 9 [4–26] weeks and 65·8 [23·8–122·1] weeks. At W24, LUs were healed for 46·5% of patients, 49·3% of LUs recurred. Univariate analyses identified inclusion LU area < 8 cm² (81·6% vs. 34·8%; P < 0·0001), inclusion LU duration < 9 weeks (65% vs. 35%; P = 0·0013), high median hemoglobin F level (P = 0·008) and low lactate dehydrogenase level (P = 0·038) as being significantly associated with complete healing at W24. Multivariate analyses retained LU area < 8 cm² (OR 6·7 [95% CI 2·35–19· 31]; P = 0·0004) and < 9 weeks' duration (OR 3·19 [1·16–8·76]; P = 0·024) as being independently associated with healing at W24. Factors independently associated with recurrence could not be identified.

Conclusions

SCD-LU complete healing is independently associated with LU clinical characteristics rather than SCD clinical or biological characteristics.

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