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  • 5-alpha reductase inhibitors Binary logistic regression Ente

    2018-11-12

    Binary logistic regression (Enter method) shows that the presence of lipodermosclerosis has a significant positive prognostic significance in healing of chronic VUs (p < 0.05). The infection proved to be the most important prognostic factor in the delay of ulcer healing (p < 0.01). The summary of the significance of the model was very high at Cox and Snell R2 = 0.43 (Figure 2).
    Discussion Venous ulcerations occur in 1% of the human population. They are frequently found in persons older than 65 years. The ratio of occurrence depending on the sex show a significant occurrence in females—at a female/male ratio of 3:1. This study shows that out of 100 tested patients, 58 (58%) were women and 42 (42%) men. The average age of patients was 62.7 ± 6.53 years, where the male 5-alpha reductase inhibitors was somewhat older. The average values of BMI as well as the waist/hip ratio were significantly higher in females. The locoregional characteristics of ulcerative changes indicate that there is no significant difference in terms of the average number of ulcers, their localization, duration, and average surface. In this study, patients were classified into two groups according to the level of present tissue granulation and fibrin in ulceration: Group I < 50% and Group II > 50% of ulceration covered by fibrin and/or granulation tissue. Higher coverage of ulceration with fibrin is found more often in males than in females, but the difference did not reach statistical significance. Ulceration coverage with a scar was found in >50% of patients of both sexes. The locoregional characteristics of chronic venous ulcerations included identification of local complications such as dermatitis, lipodermosclerosis, and infection. The statistical analysis showed that lower leg edema was significantly higher in males than in females (p < 0.05), whereas other local complications did not show any significant difference in frequency between sexes. The objectives of VU management include healing of the ulcer, prevention of recurrence, and improvement of edema. Adequate compression is regarded as the “gold standard” for VU treatment. Published healing rates of VUs obtained with compression therapy vary widely from 40% to 95%. Unfortunately, a significant number of VUs remain refractory to compression treatment. A possible way to predict nonhealing venous leg ulcers is to examine prognostic risk factors that are consistently found in a number of published studies. What is the expected healing rate of VUs with compression therapy? Nelzen et al performed a 5-year prospective cohort study to determine the prognosis of patients with chronic VUs. They found that only 44% of patients with VUs healed without recurrence. Moffat et al performed an uncontrolled study of four-layer compression bandages in the treatment of VUs. Overall, there was 69% healing at 12 weeks, but only 42% healing was achieved for ulcers >10 cm2, and 57% healing was achieved for ulcers of >6 months\' duration. Very small ulcers (0.1 cm2) of short duration (1 week) were included in this study and achieved a much higher healing rate. Several risk factors have been identified to be correlated with the delay of VU healing in patients treated with multilayer compression bandage (longer ulcer duration, large surface area, > 50% of wound surface covered with fibrin, and ABPI < 0.8)12. During the 24-week monitoring period, 25 patients (25%) did not have full healing of chronic venous ulcerations in their lower extremities. The importance of prognostic factors in the delay of VU healing was analyzed using the binary logistical regression model (enter model). The results showed that age, sex, BMI, and waist/hip ratio had no predictive significance in the delayed healing of VUs. Some studies have shown that younger age is a favorable prognostic factor for ulcer healing; in this study, however, we could not prove such a relation. The ABPI value had a more significant positive predictive value for healing ulcers (p < 0.1). The negative predictive value showed ABPI <0.8, which also has a significance level of p < 0.1.