Mottling score predicts survival in septic shock

Abstract

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.

Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock

“…Macrocirculation was assessed using MAP, heart rate (HR), CVP, and cardiac index. Microcirculatory dysfunction and organ perfusion were assessed through central venous saturation in oxygen (ScvO 2 ), arterial lactate level, urinary output [15], mottling score [9], and StO 2 . Mottling score is based on mottling area extension on legs.…”

“…Results: Fifty-two patients were included. SOFA score was 11 (9)(10)(11)(12)(13)(14)(15) and SAPS II was 56 (40-72). At 6 h after ICU admission (H6), mean arterial pressure, cardiac index, and central venous pressure were not different between non-survivors and survivors; but non-survivors had higher arterial lactate level (8.8 ± 5.0 vs. 2.2 ± 1.5 mmol/l, P \ 0.001), lower urinary output (0.22 ± 0.45 vs. 0.70 ± 0.50 ml/kg/h, P \ 0.001) and ScvO 2 (62 ± 20 vs. 72 ± 9 %, P = 0.03).…”

“…In our ICU, we were interested in clinical evaluation of microcirculation and we focused on mottling. We recently developed a mottling score based on mottling extension and reported that mottling score assessed 6 h after initial resuscitation was a strong predictive factor of 14-day mortality during septic shock [9]. Interestingly, mottling develops preferentially around the knees suggesting that the knee area could be a relevant place to explore microcirculation.…”

Research in Review: Driving Critical Care Practice Change

“…In 60 patients with septic shock, the mottling score 6 hours after the initial resuscitation was strongly associated with 14-day mortality, and patients with a higher 6-hour mottling score had increased mortality on days 1 and 2. 55 The CRT was also found to be reproducible, 56,57 although the thresholds indicative of altered perfusion vary between studies (ranging from 2.4 to 5 seconds). In 59 patients with septic shock, the index finger and knee CRTs were predictive of 14-day mortality (index finger threshold 2.4 seconds, area under curve [AUC] 84%; knee threshold 4.9 seconds, AUC 90%).…”

“…Several recent studies provide examples of how to standardize and interpret the assessment for mottling [53][54][55] and CRT. 56,57 Using laser Doppler flow, Ait-Oufella et al 53,55 measured the microvascular flow on the lower extremity, and a standardized scoring system was created (Table 2). In 60 patients with septic shock, the mottling score 6 hours after the initial resuscitation was strongly associated with 14-day mortality, and patients with a higher 6-hour mottling score had increased mortality on days 1 and 2.…”