Abstract
The current study examined to what extent individuals with wound infection (WI group), slow healing wounds (SHW group), or both (COMBI group) report poorer immune fitness and whether they experience immune-related complaints more often as compared to healthy participants (control group). Survey data from 3613 Dutch students was re-analyzed. Compared to the control group, perceived immune fitness was significantly lower by the SHW group (p < 0.001) and the COMBI group (p < 0.001), but no difference was found for the WI group (p = 0.059). Also, perceived immune fitness of the COMBI group was significantly worse compared to the WI group (p = 0.040). Compared to the control group, reduced immune fitness was reported to be significantly more frequently by the SHW group (p < 0.001) and the COMBI group (p < 0.001). Reduced immune fitness was significantly more common for the COMBI group compared to the SHW group (p = 0.011) and WI group (p = 0.001). Immune-related complaints such as headache, runny nose, coughing, sore throat, diarrhea, flu, and fever were significantly more frequently reported by individuals with impaired wound healing. The effects were most pronounced in the COMBI group, followed by the SHW group and a lesser extent the WI group. A highly significant correlation was found between perceived immune fitness and the percentage of individuals that reported impaired wound healing. In conclusion, the findings confirm that poorer immune functioning is characteristic for individuals with impaired wound healing. In follow-up studies, immune biomarkers analyses are needed to support patient-reported outcome measures.
Highlights
Chronic wounds are prevalent and constitute an underestimated public health problem [1,2]
Perceived immune fitness of the COMBI group was rated as significantly worse compared to the WI group (p = 0.040)
Reduced immune fitness was significantly more common for the COMBI group compared to the immune fitness was significantly more common for the COMBI group compared to the SHW group (p = 0.011) and WI group (p = 0.001)
Summary
Chronic wounds are prevalent and constitute an underestimated public health problem [1,2]. Chronic wounds are defined as wounds that fail to progress or respond to treatment exceeding the normal expected healing time frame [5]. The most prevalent forms of chronic wounds are leg ulcers caused by chronic venous insufficiency accounting for 70–90% of ulcers found on the lower leg, followed by diabetic foot ulcers [1,6]. Wound healing progresses through three overlapping phases: acute inflammation, proliferation and granulation tissue formation, and tissue remodeling [7,8]. The immune system is heavily involved in every stage of wound healing [9]. Crucial immune cells in mediating the inflammatory phase are neutrophils and macrophages, which together eliminate necrotic tissue, debris, and bacteria from the wound [10]. Macrophages function as the dominant cell of this stage and release several growth factors and cytokines
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