RISK FACTORS FOR CELLULITIS IN PATIENTS WITH LYMPHEDEMA: A CASE-CONTROLLED STUDY

Abstract

Risk factors for cellulitis in lymphedema(LE) have never been evaluated in controlledstudies. The objective of this study was toassess the risk factors for cellulitis in patientswith LE using a case-controlled study method.Medical records of patients from November2009 to September 2011 who met the followingcriteria were retrieved and analyzed: (a)clinical diagnosis of LE of the limb, (b) aged18 or above, (c) no food allergy history and (d)no medical diagnosis of cancer metastasis.Overall, there were 179 cases of LE withcellulitis. Each case was matched by age(± 5 years) and gender with a patient with LEand without cellulitis for controls. Logisticregression with backward selection procedurewas used to identify independent risk factors.The area under the receiver operatingcharacteristics (ROC) curve of the final modelwas calculated. Independent risk factors forcellulitis in patients with LE were percentagedifference in circumference of the limb(adjusted odds ratio (AOR)=1.07, 95%confidence interval (CI)=1.04-1.10), primaryLE diagnosis (AOR=3.36, 95% CI=1.37-8.22),food-induced complication experiences (FIE:AOR=6.82, 95% CI=2.82-16.51) and systolicblood pressure (AOR=1.02, 95% CI=1.01-1.04). The area under the curve for the modelwas 0.80 (95% CI=0.75-0.85, p<0.001). Noassociation was observed with hypertension,diabetes mellitus, body mass index and theduration of LE. This first case-controlledstudy highlights the important roles of dietaryfactors, percentage difference in circumferenceof the limb, and systolic blood pressure fordeveloping cellulitis. The results suggest thatcontrolling the percentage difference incircumference of the limb and systolic bloodpressure together with restriction of fattyfood and meat consumption may result in adecreased incidence of cellulitis amongpatients with LE.