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Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients

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Abstract

Purpose

Skin mottling is frequent and can be associated with an increased mortality rate in ICU patients with septic shock. Its overall incidence in ICU and its impact on outcome is unknown. We aimed to assess the incidence of skin mottling over the knee among all critically ill patients admitted in ICU and its role on their outcome.

Methods

An observational study over a 1-year period in a 15-bed medical ICU of a teaching hospital. Skin mottling over the knee was prospectively and qualitatively assessed by trained nurses.

Results

Incidence of skin mottling was 29% (230 of 791 patients) in overall, and 49% (32 of 65 patients) in the subset of patients admitted for septic shock. Skin mottling was present on the day on admission in 65% of patients and persisted more than 6 h in 59% of cases. In-ICU mortality was 8% in patients without mottling, 30% in patients with short skin mottling and 40% in patients with persistent skin mottling (p < 0.01 between all groups). In the overall population, skin mottling over the knee was associated with in-ICU mortality independently from SAPS II (aOR 3.29 [95% CI, 2.08–5.19], p < 0.0001). Among patients with skin mottling over the knee, persistence of skin mottling remained associated with increased in-ICU mortality independently of organ dysfunctions at the mottling onset (OR 2.77 [95% CI, 1.34–5.72], p = 0.004).

Conclusions

Skin mottling is frequent in the general population of patients admitted in ICU. Occurrence and persistence of skin mottling are independently associated with in-ICU mortality.

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Acknowledgments

We gratefully thank Jeffrey Arsham for editing the original manuscript.

Conflicts of interest

The authors report no conflict of interest.

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Authors and Affiliations

  1. Service de Réanimation Médicale, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France

    Rémi Coudroy, Angéline Jamet, Jean-Pierre Frat, Anne Veinstein, Delphine Chatellier, Véronique Goudet, Severin Cabasson, Arnaud W. Thille & René Robert

  2. INSERM U1082, Université de Poitiers, Poitiers, France

    Rémi Coudroy & René Robert

  3. INSERM CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France

    Jean-Pierre Frat & Arnaud W. Thille

Authors
  1. Rémi Coudroy
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  2. Angéline Jamet
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  3. Jean-Pierre Frat
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  4. Anne Veinstein
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  5. Delphine Chatellier
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  6. Véronique Goudet
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  7. Severin Cabasson
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  8. Arnaud W. Thille
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  9. René Robert
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Corresponding author

Correspondence to Rémi Coudroy.

Additional information

The work was performed in the medical ICU of the CHU La Milétrie, Poitiers, France.

Take-home message: Skin mottling occurs frequently in critically-ill patients, mostly in normotensive patients without vasopressors. Skin mottling and its persistence for more than 6 hours are independently associated with in-ICU mortality.

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Coudroy, R., Jamet, A., Frat, JP. et al. Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients. Intensive Care Med 41, 452–459 (2015). https://doi.org/10.1007/s00134-014-3600-5

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  • DOI: https://doi.org/10.1007/s00134-014-3600-5

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