Independent Prognostic Factors for Predicting Wound Healing in People With Venous Leg Ulcers: A Systematic Review and Meta‐Analysis

ABSTRACT

This first comprehensive systematic review aimed to summarise evidence on independent prognostic factors for wound healing in people with venous leg ulcers. In June 2025, we searched Ovid MEDLINE, Ovid Embase, CINAHL and additional resources for studies with 100 or more participants that used multivariable analyses and longitudinal data to explore the prognostic value of factors in this area. Two reviewers extracted data and assessed risk of bias using the Quality In Prognosis Studies (QUIPS) tool and certainty of evidence using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach. We synthesised studies narratively and, where applicable, pooled data using meta‐analyses. We identified 30 studies with 66,099 participants living with venous leg ulcers. We rated 14 studies at moderate risk of bias, and the remaining 16 studies were at high risk of bias. The included studies explored 116 prognostic factors. The evidence is uncertain or limited for the majority of the 116 prognostic factors. There is moderate‐certainty evidence, suggesting no association between complete healing and the factors of age in years (HR 0.99, 95% CI 0.97 to 1.0; OR 1.00, 0.99 to 1.02, for every year increment), and the presence of total deep reflux in the leg veins (HR 0.89, 0.75 to 1.05). Those having the presence of dermatitis likely have lower odds of complete healing (OR 0.51, 0.50 to 0.52). Although a wide range of factors have been investigated as potentially associated with venous leg ulcer healing, the evidence base for most is uncertain or limited.