Intensive Care Medicine

, Volume 41, Issue 3, pp 452–459 | Cite as

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

  • Rémi CoudroyEmail author
  • Angéline Jamet
  • Jean-Pierre Frat
  • Anne Veinstein
  • Delphine Chatellier
  • Véronique Goudet
  • Severin Cabasson
  • Arnaud W. Thille
  • René Robert



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.


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.


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).


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.


Shock, epidemiology Shock, mortality Critical care Epidemiologic studies 



We gratefully thank Jeffrey Arsham for editing the original manuscript.

Conflicts of interest

The authors report no conflict of interest.

Supplementary material

134_2014_3600_MOESM1_ESM.doc (314 kb)
Supplementary material 1 (DOC 314 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Rémi Coudroy
    • 1
    • 2
    Email author
  • Angéline Jamet
    • 1
  • Jean-Pierre Frat
    • 1
    • 3
  • Anne Veinstein
    • 1
  • Delphine Chatellier
    • 1
  • Véronique Goudet
    • 1
  • Severin Cabasson
    • 1
  • Arnaud W. Thille
    • 1
    • 3
  • René Robert
    • 1
    • 2
  1. 1.Service de Réanimation MédicaleCHU de PoitiersPoitiersFrance
  2. 2.INSERM U1082Université de PoitiersPoitiersFrance
  3. 3.INSERM CIC 1402 (ALIVE group)Université de PoitiersPoitiersFrance

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