Cellulitis Recurrence Score: a tool for predicting recurrence of lower limb cellulitis

Abstract

Background: Cellulitis is the most common skin and soft tissue infection and is associated with frequent recurrences.

Objectives: An objective of our study was to identify factors for recurrence in patients who present with a first episode of lower-limb cellulitis. A secondary aim was to formulate a score based on observed clinical risk factors that might predict recurrence within a year.

Methods: Dermatology referral forms and national computerized records were reviewed from 2003 to 2012. Demographics, coexistent dermatoses, local factors, and comorbidities were reviewed.

Results: A total of 102 (45.3%) of 225 patients had recurrence. Multivariate analysis showed that lymphedema (P < .0005), chronic venous insufficiency (P < .0005), peripheral vascular disease (P = .002), and deep vein thrombosis (P = .008) predicted for recurrence. The Cellulitis Recurrence Score (CRS) was constructed based on these factors. CRS ≥ 2 was associated with a positive predictive value of 83.6% and negative predictive value of 67.5%. Model performance was good (Hosmer-Lemeshow statistic, P = .753).

Limitations: This is a retrospective study limited to an inpatient cohort.

Conclusion: Lymphedema, chronic venous insufficiency, peripheral vascular disease, and deep vein thrombosis were risk factors. CRS is reliable for predicting recurrence, and early interventions should be considered in patients with CRS ≥ 2.

Keywords: cellulitis; chronic venous insufficiency; deep vein thrombosis; erysipelas; lymphedema; peripheral vascular disease; recurrence; stasis dermatitis.