Impact of protein deficiency on venous ulcer healing

Objective: The prevalence of protein deficiency and its impact on wound healing is not known for leg ulcers. The aim of this study was to determine the prevalence of protein deficiency in outpatients presenting with leg ulcers and the parameter's prognostic value for wound outcome. Design of study: Prospective controlled observational study. Setting: Ambulatory patients referred for chronic wounds to four university hospitals. Methods: Consecutive out-patients with a leg ulcer present for at least 2 months, related to venous insufficiency, associated or not with moderate peripheral arterial disease (ankle-brachial pressure index > 0.7), were included in a prospective study. Wound evaluation (area and occurrence of complications) was performed at baseline and at 12 weeks of follow-up. Biologic nutrition assessment (serum albumin, transthyretin, c-reactive protein) was performed at baseline. The control group consisted of consecutive patients free of leg ulceration and attending the dermatology outpatient clinic for remissive skin cancer or miscellaneous skin disorders. Results: Forty one patients and 43 controls were included. Serum albumin level was under 35 g/L (normal values: 36-44 g/L) in 27% of the patients and 2% of the controls (P < .001). At 12 weeks, 34% of the patients had an increase in wound area. Wound infections occurred in 12% (n = 5) of the patients. Protein deficiency was independently associated with an increase in wound area at 12 weeks (P = .034) and the presence of all inflammatory syndrome was associated with the occurrence of wound complications (wound infection or hospitalization) during follow-up (P < .001). Conclusion: The prevalence of protein deficiency in out-patients with leg ulcers is high and significantly associated with a poor healing prognosis.