Early changes in immune-inflammatory indices and healing outcomes in pressure injuries patients: A retrospective study
Jingwei Wang, Xiaojie ZhaoBackground
Early prediction of wound healing after flap reconstruction for stage IV pressure injuries remains challenging. This study evaluated the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) as predictors of healing outcomes.
Methods
This retrospective cohort study included 127 patients with stage IV pressure injuries who underwent negative-pressure wound therapy and flap reconstruction between January 2020 and December 2024. Blood samples were collected at baseline, 72 hours, day 7, and day 14 post-surgery. The primary outcome was complete wound healing. Receiver operating characteristic curve analysis was used to assess the predictive performance of inflammatory indices.
Results
Complete healing was achieved in 72 patients (56.7%) over a median follow-up of 18 weeks. The delayed/non-healing group had higher baseline NLR (9.2 vs 6.0, P<0.001) and SII (2068.3 vs 1351.2, P<0.001). Day 7 NLR reduction was greater in the healing group (-22.9% vs -10.6%, P<0.001). Baseline SII had the highest predictive value among individual markers (area under the curve [AUC] 0.774). Day 7 NLR change achieved AUC 0.784. The combined model incorporating baseline NLR and day 7 NLR change yielded an AUC of 0.838, with 81.9% sensitivity and 70.9% specificity. Time-dependent analysis showed consistent performance across 30-day, 60-day, and 90-day time points (AUC 0.798-0.838).
Conclusions
Baseline SII and NLR, combined with early dynamic changes, may serve as potential predictors of healing after flap reconstruction for stage IV pressure injuries. Early assessment of NLR trajectory may provide adjunctive prognostic information, though prospective validation is required.