title: Quantitative analysis of blood cells and inflammatory factors in wounds.
abstract: OBJECTIVE
  The aim of this study was to quantify blood cells and inflammatory markers, involved in the healing process, in exudates from wounds in different healing phases, to assess these markers in order to identify the inflammatory phase of the wounds.
  
  
  METHODS
  Patients who presented with postsurgical wounds, which closed by first and second intention, and those who presented with pressure ulcers (PUs), which were closed by second intention, were included in the study.
  
  
  RESULTS
  We examined wounds from 37 patients and collected samples from 52 wounds in the inflammatory phase, 30 in the proliferative phase and 29 in the maturation phase. The number of neutrophils and platelets in the exudate collected from wounds in the inflammatory phase was significantly higher (p<0.001), while the number of lymphocytes, was significantly lower in exudate from wounds in the inflammatory phase (p<0.001). Wound c-reactive protein (CRP) and immunoglobulin G (IgG) levels were higher in the inflammatory group (p<0.001). We found a significantly positive correlation between CRP levels and the percentage of neutrophils and monocytes (r=0.346, p=0.004; r=0.293, p=0.015), and a significantly negative correlation between CRP levels and the percentage of lymphocytes (r=-0.503, p<0.001). A stepwise logistic regression analysis was used to identify an optimal combination of these biomarkers. The optimal biomarker combinations were neutrophils + monocytes + platelets + IgG + CRP, with an area under the curve (AUC) of 0.981 [confidence interval (CI) 95%: 0.955-1.000, p<0.001] for the diagnosis of wounds in the inflammatory phase. The optimal cutpoint yielded 96.9 % sensitivity and 94.6 % specificity. The biomarker combination predicted the inflammatory phase and was superior to individual biomarkers.
  
  
  CONCLUSIONS
  Our findings suggest that the combination of the markers, percentage of neutrophils and monocytes, platelets, CRP and IgG levels could be useful prognostic indicators of the inflammatory phase.
authors.affiliation: Wound Department, General University Hospital of Elche (Alicante), Spain.
authors.forename: S
authors.initials: S
authors.lastname: Cerveró-Ferragut
authors.affiliation: Department of Laboratory Medicine, University Clinical Hospital Virgen de la Arrixaca, El Palmar (Murcia), Spain.
authors.forename: N
authors.initials: N
authors.lastname: López-Riquelme
authors.affiliation: Laboratory Medicine Department, General University Hospital of Elche (Alicante), Spain.
authors.forename: E
authors.initials: E
authors.lastname: Martín-Tomás
authors.affiliation: Wound Department, General University Hospital of Elche (Alicante), Spain.
authors.forename: B
authors.initials: B
authors.lastname: Massa-Domínguez
authors.affiliation: Wound Department, General University Hospital of Elche (Alicante), Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pomares-Vicente
authors.affiliation: Wound Department, General University Hospital of Elche (Alicante), Spain.
authors.forename: M
authors.initials: M
authors.lastname: Soler-Pérez
authors.affiliation: Laboratory Medicine Department, General University Hospital of Elche (Alicante), Spain.
authors.forename: J F
authors.initials: JF
authors.lastname: Sánchez-Hernández
mesh_terms: D015415:Biomarkers / Q000097:blood*; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D003668:Pressure Ulcer / Q000097:blood*; D014945:Wound Healing; D014947:Wounds and Injuries / Q000097:blood
chemical_list: D015415:Biomarkers; D016207:Cytokines
keywords: inflammatory markers; inflammatory phase; leukocytes; proliferative phase; wound exudate