Factors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT)
Abstract Background Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an internationa...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08839-z |
| _version_ | 1797350159183511552 |
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| author | Ewa Anna Burian Peter J. Franks Pinar Borman Isabelle Quéré Tonny Karlsmark Vaughan Keeley Junko Sugama Marina Cestari Christine J. Moffatt |
| author_facet | Ewa Anna Burian Peter J. Franks Pinar Borman Isabelle Quéré Tonny Karlsmark Vaughan Keeley Junko Sugama Marina Cestari Christine J. Moffatt |
| author_sort | Ewa Anna Burian |
| collection | DOAJ |
| description | Abstract Background Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis. Methods An international, multi-centre, cross-sectional study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient’s best interest were excluded. Both univariable and multivariable analysis were performed. Results A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1–2 years (OR 2.15), 2–5 years (OR 2.86), 5–10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39–0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis. Conclusion Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis. |
| first_indexed | 2024-03-08T12:40:45Z |
| format | Article |
| id | doaj.art-d0ff54d474684778af1becf7ca145b60 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-08T12:40:45Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-d0ff54d474684778af1becf7ca145b602024-01-21T12:12:06ZengBMCBMC Infectious Diseases1471-23342024-01-0124111110.1186/s12879-023-08839-zFactors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT)Ewa Anna Burian0Peter J. Franks1Pinar Borman2Isabelle Quéré3Tonny Karlsmark4Vaughan Keeley5Junko Sugama6Marina Cestari7Christine J. Moffatt8Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg HospitalCentre for Research and Implementation of Clinical PracticeMedical Faculty, Department of Physical Medicine and Rehabilitation, Ankara Medipol UniversityCHU Montpellier, University of Montpellier, IDESPDepartment of Dermato-Venereology & Wound Healing Centre, Bispebjerg HospitalLymphoedema Department, University Hospitals of Derby and Burton NHS Trust, Derby and University of Nottingham Medical SchoolResearch Centre for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health UniversityPianeta Linfedema Study CentreDepartment of Dermato-Venereology & Wound Healing Centre, Bispebjerg HospitalAbstract Background Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis. Methods An international, multi-centre, cross-sectional study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient’s best interest were excluded. Both univariable and multivariable analysis were performed. Results A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1–2 years (OR 2.15), 2–5 years (OR 2.86), 5–10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39–0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis. Conclusion Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis.https://doi.org/10.1186/s12879-023-08839-zCellulitisErysipelasLymphedemaLymphoedemaChronic edemaBreast-neoplasm |
| spellingShingle | Ewa Anna Burian Peter J. Franks Pinar Borman Isabelle Quéré Tonny Karlsmark Vaughan Keeley Junko Sugama Marina Cestari Christine J. Moffatt Factors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT) BMC Infectious Diseases Cellulitis Erysipelas Lymphedema Lymphoedema Chronic edema Breast-neoplasm |
| title | Factors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT) |
| title_full | Factors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT) |
| title_fullStr | Factors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT) |
| title_full_unstemmed | Factors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT) |
| title_short | Factors associated with cellulitis in lymphoedema of the arm – an international cross-sectional study (LIMPRINT) |
| title_sort | factors associated with cellulitis in lymphoedema of the arm an international cross sectional study limprint |
| topic | Cellulitis Erysipelas Lymphedema Lymphoedema Chronic edema Breast-neoplasm |
| url | https://doi.org/10.1186/s12879-023-08839-z |
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