Stratification of Highest-Risk Patients with Chronic Skin Ulcers in a Stanford Retrospective Cohort Includes Diabetes, Need for Systemic Antibiotics, and Albumin Levels

Abstract

Chronic nonsurgical skin wounds such as venous stasis and diabetic ulcers have been associated with a number of comorbid conditions; however, the strength of these associations has not been compared. We utilized the Stanford Translational Research Integrated Database Environment (STRIDE) system to identify a cohort of 637 patients with chronic skin ulcers. Preliminary analysis (n = 300) showed that 49.7% of the patients had a poor prognosis such as amputation or a nonhealing ulcer for at least a year. Factors significantly associated (P < 0.05) with these outcomes included diabetes mellitus, chronic kidney disease, peripheral neuropathy, peripheral arterial disease, and need for systemic antibiotics. Patients with poor outcomes also tended to have lower hemoglobin levels (P = 0.01), higher WBC levels (P < 0.01), and lower albumin levels (P < 0.01). On multivariate analysis, however, only diabetes mellitus (OR 5.87,3), need for systemic antibiotics (OR 3.88,, and albumin levels (0.20 per unit, 0.07-0.60) remained significant independent predictors of poor wound-healing outcomes. These data identify patients at the highest risk for poor wound-healing and who may benefit the most from more aggressive wound care and treatment.

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“…However, many other studies have noted diabetes as a significant risk factor for wound complications. [11][12][13]18 After stepwise selection, diabetes status did not show significance in the final MLR model in this study, which means that diabetes status had no correlation with major or minor wound complications in our cohort of patients. The majority of diabetic patients (76.21%) had a drain placed in this study (Table 2).…”

“…001), and patients with diabetes (P = .0025), a well-established risk factor for wound complications, were more likely to have a drain placed. [11][12][13][25][26][27][28][29] Also, Table 2 shows that patients with low preoperative platelet counts were more likely to be assigned to the drain group (203 compared with 175 for ND and D groups) (P < .001).…”

“…Prognosticators include diabetes, a high body mass index (BMI), poor nutrition status, delayed graft function (DGF), longer operative times, advanced age, poor surgical technique, and nicotine consumption. 1,[5][6][7][8][9][10][11][12][13] The immunosuppressant regimen plays an integral role in the development of wound issues. Sirolimus, an mTOR inhibitor, has a well-known association with wound complications.…”

Effect of Therapeutic Dietary Regimen on Wound Healing For Patients with Moderate Degree Burn

“…This result is contradicted by Vanek(1998) who reported that serum albumin is a poor nutritional marker, but it is a good prognostic marker correlating with morbidity and mortality in hospitalized patients. For that reason, it's hardly surprising that hypoalbuminaemia is associated with increased mortality and prolonged length of stay in ICU (37)(38)(39)(40) .…”

Nutrition and Chronic Wounds: Improving Clinical Outcomes

“…Amir et al in a recent review (2012) found that albumin levels were one of the most significant independent predictors of poor wound healing outcomes in chronic wounds. 51 Many clinicians are not aware of the potential nutritional information in the complete blood count. Presence of a microcytic hypochromic anemia may represent iron deficiency, as well as anemia of chronic disease associated with PCM.…”