title: Factors predictive of leg-ulcer healing in sickle cell disease: a multicentre, prospective cohort study.
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.
  
  
  OBJECTIVE
  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.affiliation: Service de Dermatologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (APHP), 4 Rue de la Chine, Paris CEDEX 20, 75970, France.
authors.forename: P
authors.initials: P
authors.lastname: Senet
authors.affiliation: Service de Rééducation Vasculaire, Hôpital Corentin-Celton, APHP, 4 Parvis Corentin-Celton, BP 66, Issy-les-Moulineaux CEDEX, 92133, France.
authors.forename: C
authors.initials: C
authors.lastname: Blas-Chatelain
authors.affiliation: 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.
authors.forename: P
authors.initials: P
authors.lastname: Levy
authors.affiliation: 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.
authors.forename: E M
authors.initials: EM
authors.lastname: Manea
authors.affiliation: Inserm/UEVE UMR 861, I-Stem, AFM, Génopôle Campus 1, Évry, France.
authors.forename: M
authors.initials: M
authors.lastname: Peschanski
authors.affiliation: Service de Rééducation Vasculaire, Hôpital Corentin-Celton, APHP, 4 Parvis Corentin-Celton, BP 66, Issy-les-Moulineaux CEDEX, 92133, France.
authors.forename: T
authors.initials: T
authors.lastname: Mirault
authors.affiliation: Service de Médecine Interne, Centre de Référence de la Drépanocytose, Hôpital Tenon, APHP and Université Pierre et Marie Curie, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Stankovic-Stojanovic
authors.affiliation: Service de Rééducation Vasculaire, Hôpital Corentin-Celton, APHP, 4 Parvis Corentin-Celton, BP 66, Issy-les-Moulineaux CEDEX, 92133, France.
authors.forename: C
authors.initials: C
authors.lastname: Debure
authors.affiliation: 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.
authors.forename: K
authors.initials: K
authors.lastname: Debbache
authors.affiliation: Service de Médecine Interne, Centre de Référence de la Drépanocytose, Hôpital Tenon, APHP and Université Pierre et Marie Curie, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Girot
authors.affiliation: Service de Rééducation Vasculaire, Hôpital Corentin-Celton, APHP, 4 Parvis Corentin-Celton, BP 66, Issy-les-Moulineaux CEDEX, 92133, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Bureau
authors.affiliation: Service de Médecine Interne, Centre de Référence de la Drépanocytose, Hôpital Tenon, APHP and Université Pierre et Marie Curie, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Bachmeyer
authors.affiliation: Inserm/UEVE UMR 861, I-Stem, AFM, Génopôle Campus 1, Évry, France.
authors.forename: C
authors.initials: C
authors.lastname: Baldeschi
authors.affiliation: 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.
authors.forename: F
authors.initials: F
authors.lastname: Galacteros
authors.affiliation: Service de Médecine Interne, Centre de Référence de la Drépanocytose, Hôpital Tenon, APHP and Université Pierre et Marie Curie, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Lionnet
authors.affiliation: Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire Poitires, 86021, Poitiers, France.
authors.forename: J
authors.initials: J
authors.lastname: Gellen-Dautremer
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000503:physiopathology*; D058128:Compression Bandages; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D014945:Wound Healing / Q000502:physiology*