Cellulitis in chronic oedema of the lower leg: an international cross-sectional study

Background Cellulitis and chronic oedema are common conditions with considerable morbidity. The number of studies designed to assess the epidemiology of cellulitis in chronic oedema is scarce. Objectives To investigate the prevalence and risk factors of cellulitis in chronic leg oedema, including lymphoedema. Methods A cross-sectional study included 40 sites in nine countries during 2014-17. Adults with clinically proven unilateral or bilateral chronic oedema (oedema > 3 months) of the lower leg were included. The main outcome measures were frequency and risk factors for cellulitis within the last 12 months. Results Out of 7477 patients, 15 center dot 78% had cellulitis within the last 12 months, with a lifetime prevalence of 37 center dot 47%. The following risk factors for cellulitis were identified by multivariable analysis: wounds [odds ratio (OR) 2 center dot 37, 95% confidence interval (CI) 2 center dot 03-2 center dot 78], morbid obesity (OR 1 center dot 51, 95% CI 1 center dot 27-1 center dot 80), obesity (OR 1 center dot 21, 95% CI 1 center dot 03-1 center dot 41), midline swelling (OR 1 center dot 32, 95% CI 1 center dot 04-1 center dot 66), male sex (OR 1 center dot 32, 95% CI 1 center dot 15-1 center dot 52) and diabetes (OR 1 center dot 27, 95% CI 1 center dot 08-1 center dot 49). Controlled swelling was associated with a reduced risk (OR 0 center dot 59, 95% CI 0 center dot 51-0 center dot 67). In a subgroup analysis, the risk increased with the stage of oedema [International Society of Lymphology, stage II OR 2 center dot 04 (95% CI 1 center dot 23-3 center dot 38) and stage III OR 4 center dot 88 (95% CI 2 center dot 77-8 center dot 56)]. Conclusions Cellulitis in chronic leg oedema is a global problem. Several risk factors for cellulitis were identified, of which some are potentially preventable. Our findings suggest that oedema control is one of these. We also identified that advanced stages of oedema, with hard/fibrotic tissue, might be an important clinical indicator to identify patients at particular risk.

Automated summary

This study investigated the prevalence and risk factors of cellulitis in chronic leg oedema patients, identifying key risk factors including wounds, obesity, male sex, and diabetes. The findings suggest that controlling oedema can reduce the risk of cellulitis, and that advanced stages of oedema may indicate higher risk of developing cellulitis.