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Mottling score predicts survival in septic shock

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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.

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Conflict of interest

The authors had no conflict of interest.

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Authors and Affiliations

  1. Service de Réanimation Médicale, AP-HP, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France

    H. Ait-Oufella, S. Lemoinne, A. Galbois, J. L. Baudel, J. Lemant, J. Joffre, D. Margetis, B. Guidet, E. Maury & G. Offenstadt

  2. Inserm U970, Paris Research Cardiovascular Center, Paris, France

    H. Ait-Oufella

  3. Service de santé publique, AP-HP, Hôpital Saint-Antoine, 75012, Paris, France

    P. Y. Boelle

  4. Université Pierre et Marie Curie-Paris 6, UMR S707, 75012, Paris, France

    P. Y. Boelle, B. Guidet, E. Maury & G. Offenstadt

  5. Inserm U707, 75012, Paris, France

    P. Y. Boelle, B. Guidet, E. Maury & G. Offenstadt

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  1. H. Ait-Oufella
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  2. S. Lemoinne
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  3. P. Y. Boelle
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  4. A. Galbois
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  6. J. Lemant
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  8. D. Margetis
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  9. B. Guidet
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  10. E. Maury
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  11. G. Offenstadt
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Correspondence to H. Ait-Oufella.

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Ait-Oufella, H., Lemoinne, S., Boelle, P.Y. et al. Mottling score predicts survival in septic shock. Intensive Care Med 37, 801–807 (2011). https://doi.org/10.1007/s00134-011-2163-y

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  • DOI: https://doi.org/10.1007/s00134-011-2163-y

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