Predictors of Short-Term Outcome in Venous Leg Ulcers: The Dominant Role of Wound Infection and Multiple Ulcers

Background/Objectives: CEAP C6 venous leg ulcers are the most resource-intensive stage of chronic venous disease, yet short-term prognostication at admission remains empirical. We aimed to determine which routinely available admission variables are associated with unfavourable in-episode evolution and to develop a concise prognostic model. Methods: Single-centre retrospective observational cohort of 87 consecutive patients; in-episode evolution (favourable versus unfavourable) was documented in 59. Associations were tested by univariate methods and binary logistic regression. Because outcome was undocumented in 32.2% of the cohort, a tipping-point sensitivity analysis quantified the departure from a missing-at-random mechanism required to nullify each association. Results: Wound infection was recorded in 69.0% of patients, with Pseudomonas spp. and meticillin-sensitive Staphylococcus aureus predominating. Evolution was unfavourable in 34/59 patients (57.6%) and was associated with wound infection (OR 7.00, 95% CI 2.13–23.03), microbial eczema, multiple ulceration and urban residence, but with neither the neutrophil-to-lymphocyte ratio (p = 0.920) nor any individual comorbidity. In the final model, wound infection (OR 6.10), urban residence (OR 5.81) and multiple ulceration (OR 5.01) were independently associated with outcome (Nagelkerke R2 = 0.405; AUC 0.812, 95% CI 0.704–0.919). Sensitivity analysis showed the wound infection association to be robust to informative missingness, whereas urban residence was the most fragile. Conclusions: Wound-level factors—infection and multiple ulcers—carried more short-term prognostic information than comorbidity burden or systemic inflammatory indices. These findings are hypothesis-generating and require external validation.