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Intensive Care Medicine

, Volume 37, Issue 5, pp 801–807 | Cite as

Mottling score predicts survival in septic shock

  • H. Ait-OufellaEmail author
  • S. Lemoinne
  • P. Y. Boelle
  • A. Galbois
  • J. L. Baudel
  • J. Lemant
  • J. Joffre
  • D. Margetis
  • B. Guidet
  • E. Maury
  • G. Offenstadt
Original

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.

Keywords

Shock Microcirculation Prognosis Mottling Intensive care medicine 

Notes

Conflict of interest

The authors had no conflict of interest.

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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • H. Ait-Oufella
    • 1
    • 2
    Email author
  • S. Lemoinne
    • 1
  • P. Y. Boelle
    • 3
    • 4
    • 5
  • A. Galbois
    • 1
  • J. L. Baudel
    • 1
  • J. Lemant
    • 1
  • J. Joffre
    • 1
  • D. Margetis
    • 1
  • B. Guidet
    • 1
    • 4
    • 5
  • E. Maury
    • 1
    • 4
    • 5
  • G. Offenstadt
    • 1
    • 4
    • 5
  1. 1.Service de Réanimation MédicaleAP-HP, Hôpital Saint-AntoineParis Cedex 12France
  2. 2.Inserm U970, Paris Research Cardiovascular CenterParisFrance
  3. 3.Service de santé publiqueAP-HP, Hôpital Saint-AntoineParisFrance
  4. 4.Université Pierre et Marie Curie-Paris 6, UMR S707ParisFrance
  5. 5.Inserm U707ParisFrance

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