Bui Ut T, Finlayson Kathleen, Edwards Helen
Faculty of Health, School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia.
Wound Management Innovation Cooperative Research Centre, West End, Qld, Australia.
Int J Clin Pract. 2018 Dec;72(12):e13263. doi: 10.1111/ijcp.13263. Epub 2018 Sep 21.
This study aimed to validate the relationships between possible predictive factors and clinically diagnosed infection in adult patients with chronic leg ulcers.
This study used a sample of 636 adult participants whose ulcers were diagnosed as either venous, arterial or mixed aetiology leg ulcers and had no clinical signs of infection at recruitment. Data were extracted from recruitment to 12 weeks from six longitudinal prospective studies from 2004 to 2015. Survival analysis was used to investigate mean time-to-infection, including the Kaplan-Meier method and the Cox proportional-hazards regression model.
The sample included 74.7% venous, 19.6% mixed and 5.7% arterial leg ulcers. There were 101 (15.9%) participants diagnosed with infection at least once within 12 weeks of follow-up. Mean time-to-infection was 10.89 weeks (95% CI = 10.66-11.12). After adjustment for potential confounders, a Cox proportional hazards regression model found that depression, using walking aids, calf ankle ratio <1.3, wound area ≥10 cm and ulcers with slough tissue at recruitment were significant risk factors for wound infection.
This study has validated the predictive ability of factors which have been found in a cross-sectional study to be significantly associated with infection in patients with leg ulcers, including venous leg ulcers, arterial leg ulcers and mixed aetiology leg ulcers. Results showed that patients with chronic leg ulcers, who either presented with depression, used walking aids, had a calf ankle ratio <1.3, a wound area ≥10 cm or an ulcer with slough tissue, had greater likelihood of developing infection compared to those without these factors.
本研究旨在验证成年慢性腿部溃疡患者中可能的预测因素与临床诊断感染之间的关系。
本研究采用了636名成年参与者的样本，他们的溃疡被诊断为静脉性、动脉性或混合病因的腿部溃疡，且在招募时无感染的临床体征。数据从2004年至2015年的六项纵向前瞻性研究的招募阶段提取至12周。生存分析用于研究感染的平均时间，包括Kaplan-Meier方法和Cox比例风险回归模型。
样本包括74.7%的静脉性、19.6%的混合性和5.7%的动脉性腿部溃疡。有101名（15.9%）参与者在随访的12周内至少被诊断出感染一次。感染的平均时间为10.89周（95%置信区间=10.66-11.12）。在对潜在混杂因素进行调整后，Cox比例风险回归模型发现，抑郁、使用助行器、小腿-脚踝比值<1.3、伤口面积≥10平方厘米以及招募时伴有腐肉组织的溃疡是伤口感染的显著危险因素。
本研究验证了在横断面研究中发现的与腿部溃疡患者感染显著相关的因素的预测能力，这些腿部溃疡包括静脉性腿部溃疡、动脉性腿部溃疡和混合病因腿部溃疡。结果表明，与没有这些因素的患者相比，患有慢性腿部溃疡且伴有抑郁、使用助行器、小腿-脚踝比值<1.3、伤口面积≥10平方厘米或伴有腐肉组织溃疡的患者发生感染的可能性更大。
