Mottling score predicts survival in septic shock.

Abstract

BACKGROUND:

Experimental and clinical studies have identified a crucial role of microcirculation impairment in severe infections. We hypothesized that mottling, a sign of microcirculation alterations, was correlated to survival during septic shock.

METHODS:

We conducted a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included during a 7-month period. After initial resuscitation, we recorded hemodynamic parameters and analyzed their predictive value on mortality. The mottling score (from 0 to 5), based on mottling area extension from the knees to the periphery, was very reproducible, with an excellent agreement between independent observers [kappa = 0.87, 95% CI (0.72-0.97)].

RESULTS:

Sixty patients were included. The SOFA score was 11.5 (8.5-14.5), SAPS II was 59 (45-71) and the 14-day mortality rate 45% [95% CI (33-58)]. Six hours after inclusion, oliguria [OR 10.8 95% CI (2.9, 52.8), p = 0.001], arterial lactate level [<1.5 OR 1; between 1.5 and 3 OR 3.8 (0.7-29.5); >3 OR 9.6 (2.1-70.6), p = 0.01] and mottling score [score 0-1 OR 1; score 2-3 OR 16, 95% CI (4-81); score 4-5 OR 74, 95% CI (11-1,568), p < 0.0001] were strongly associated with 14-day mortality, whereas the mean arterial pressure, central venous pressure and cardiac index were not. The higher the mottling score was, the earlier death occurred (p < 0.0001). Patients whose mottling score decreased during the resuscitation period had a better prognosis (14-day mortality 77 vs. 12%, p = 0.0005).

CONCLUSION:

The mottling score is reproducible and easy to evaluate at the bedside. The mottling score as well as its variation during resuscitation is a strong predictor of 14-day survival in patients with septic shock.

• Authors: H Ait-Oufella, S Lemoinne, P Y Boelle, A Galbois, J L Baudel, J Lemant, J Joffre, D Margetis, B Guidet, E Maury, G Offenstadt
• Journal: Intensive care medicine (Intensive Care Med) Vol. 37 Issue 5 Pg. 801-7 (May 2011) ISSN: 1432-1238 [Electronic] United States
• PMID: 21373821 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Diagnostic Tests, Routine
• Female
• Hospitals, Teaching
• Humans
• Intensive Care Units
• Male
• Microcirculation (immunology, physiology)
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Shock, Septic (mortality, physiopathology)
• Skin (blood supply)
• Survival Analysis