Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters

• Published in: Critical care (London, England) Vol. 23; no. 1; pp. 211 - 9
• Main Authors: Dumas, Guillaume, Lavillegrand, Jean-Rémi, Joffre, Jérémie, Bigé, Naïke, de-Moura, Edmilson Bastos, Baudel, Jean-Luc, Chevret, Sylvie, Guidet, Bertrand, Maury, Eric, Amorim, Fabio, Ait-Oufella, Hafid
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.06.2019; BioMed Central; BMC
• Subjects: Aged; Aged, 80 and over; Brazil; Critical care; Death; Diagnosis; Dosage and administration; Drug therapy; Female; Fluid Therapy - methods; Heart rate; Human health and pathology; Humans; Infection; Infectious diseases; Intensive care; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Kidneys; Lactates; Life Sciences; Male; Medical tests; Methods; Microcirculation; Microcirculation - physiology; Middle Aged; Mortality; Mortality - trends; Mottling; Outcome; Patient outcomes; Patients; Perfusion (Physiology); Prognosis; Risk factors; Santé publique et épidémiologie; Sepsis; Sepsis - drug therapy; Sepsis - mortality; Septic shock; Severity of Illness Index; Shock; Skin; Sufentanil; Systematic review; Treatment Outcome; Urine; Vasoconstrictor agents; Vasoconstrictor Agents - administration & dosage; Vasoconstrictor Agents - therapeutic use; Vasopressor; Brazil; Vasopressor; Microcirculation; Septic shock; Mottling; Outcome
• ISSN: 1364-8535; 1466-609X; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-019-2496-4

Mottling score, a tissue perfusion parameter, is correlated with outcome in septic shock patients. However, its predictive value on mortality according to prognostic covariates such as vasopressor dose and other tissue perfusion parameters remains unknown. Mottling score and tissue perfusion parameters were recorded at ICU admission (H0), H-6, H 12, and H-24 and used to assess the predictive value of mottling score on 14-day mortality in a development cohort. Results were then validated in an independent cohort of septic shock patients in Brazil. Overall, 259 patients with sepsis or septic shock were included, 14-day mortality was 37%. Factors associated with death were mottling score (OR 2.26 [95% CI, 1.72-2.97]), arterial lactate level (OR 1.29 [1.11-1.5]), and urine output < 0.5 ml/Kg/h (OR 3.03 [1.37-6.69]). The C statistic for the model was 0.90 in the development cohort and 0.76 in the validation cohort. The predictive value of mottling score was not affected by vasopressor doses (p for interaction = 0.33): OR for mottling score ranged from 2.34 [1.10-3.15] in patients without vasopressor to 3.84 [1.98-7.43] in patients infused with high doses of vasopressor (> 0.8 μg/kg/min). There was no difference in the effect of mottling score on mortality according to mean arterial pressure, heart rate, cardiac index, and urine output, but we found a significant interaction between arterial lactate level and mottling score (p = 0.04). The predictive value of the mottling score remains significant when using the recent SEPSIS-3 definition of septic shock. Finally, a decrease of mottling score during resuscitation was significantly associated with better outcome after adjustment on SOFA score (p = 0.001). Our results support the high prognostic value of mottling score for 14-day mortality in septic patients, whatever vasopressor dosage and other perfusion parameters. Mottling score variations during resuscitation are also predictive of mortality.