Arnaud Galbois1, Naïke Bigé2, Claire Pichereau2, Pierre-Yves Boëlle3, Jean-Luc Baudel4, Simon Bourcier2, Eric Maury5, Bertrand Guidet5, Hafid Ait-Oufella6. 1. AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; INSERM, UMR_S 938, CdR Saint-Antoine, F-75012 Paris, France. Electronic address: galbois@gmail.com. 2. AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France. 3. Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; AP-HP, Hôpital Saint-Antoine, Service de Santé Publique, F-75012 Paris, France; INSERM, UMR_S 707, F-75012 Paris, France. 4. AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France. 5. AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; INSERM, UMR_S 707, F-75012 Paris, France. 6. AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; Paris Research Cardiovascular Center, Inserm U970, Paris, France.
Abstract
BACKGROUND & AIMS: Skin perfusion alterations are early and strong predictors of death in patients with septic shock. Cirrhosis is associated with systemic vasodilation and increases mortality from septic shock. We aimed at assessing whether the mottling score and tissue oxygen saturation (StO2) could be used as early predictors of death in cirrhotic patients with septic shock. METHODS: This observational study included cirrhotic patients with septic shock. Each 6 h during the first 24 h, we collected data reflecting macrocirculation (mean arterial pressure, heart rate, central venous pressure, and cardiac output) and organ perfusion (arterial lactate, urinary output, ScvO2, mottling score, thenar, and knee StO2). Data of 75 non-cirrhotic patients with previously reported septic shock were used as control. RESULTS: 42 cirrhotic patients were included. Mortality at day 14 was 71%. At H6, parameters reflecting macrocirculation were not associated with mortality, whereas higher arterial lactate and mottling score were associated with death. Mottling score was the strongest predictor of mortality (sensitivity=0.63, specificity=1, OR=42.4 (2.3-785.9)). At H6, knee StO2 decreased in non-survivors and predicted death (sensitivity=0.45, specificity=1). In comparison with control, mottling kinetic was different in cirrhotic patients (delayed mottling appearance in non-survivors, earlier mottling disappearance in survivors). Knee StO2 and skin perfusion, assessed by laser-Doppler, were higher in cirrhotic patients. CONCLUSIONS: Mottling score and knee StO2 at H6 were very specific predictors of death in patients with cirrhosis and septic shock. Their sensitivity was lower in cirrhotic patients due to delayed mottling appearance and higher knee StO2 related to higher skin perfusion.
BACKGROUND & AIMS: Skin perfusion alterations are early and strong predictors of death in patients with septic shock. Cirrhosis is associated with systemic vasodilation and increases mortality from septic shock. We aimed at assessing whether the mottling score and tissue oxygen saturation (StO2) could be used as early predictors of death in cirrhoticpatients with septic shock. METHODS: This observational study included cirrhotic patients with septic shock. Each 6 h during the first 24 h, we collected data reflecting macrocirculation (mean arterial pressure, heart rate, central venous pressure, and cardiac output) and organ perfusion (arterial lactate, urinary output, ScvO2, mottling score, thenar, and knee StO2). Data of 75 non-cirrhotic patients with previously reported septic shock were used as control. RESULTS: 42 cirrhotic patients were included. Mortality at day 14 was 71%. At H6, parameters reflecting macrocirculation were not associated with mortality, whereas higher arterial lactate and mottling score were associated with death. Mottling score was the strongest predictor of mortality (sensitivity=0.63, specificity=1, OR=42.4 (2.3-785.9)). At H6, knee StO2 decreased in non-survivors and predicted death (sensitivity=0.45, specificity=1). In comparison with control, mottling kinetic was different in cirrhotic patients (delayed mottling appearance in non-survivors, earlier mottling disappearance in survivors). Knee StO2 and skin perfusion, assessed by laser-Doppler, were higher in cirrhotic patients. CONCLUSIONS: Mottling score and knee StO2 at H6 were very specific predictors of death in patients with cirrhosis and septic shock. Their sensitivity was lower in cirrhotic patients due to delayed mottling appearance and higher knee StO2 related to higher skin perfusion.
Authors: Edmilson Bastos de Moura; Fábio Ferreira Amorim; Alfredo Nicodemos da Cruz Santana; Gabriel Kanhouche; Lucas Garcia de Souza Godoy; Lucila de Jesus Almeida; Thais Almeida Rodrigues; Carlos Darwin Gomes da Silveira; Marcelo de Oliveira Maia Journal: Intensive Care Med Date: 2015-12-19 Impact factor: 17.440
Authors: Danillo Menezes Dos Santos; Jullyana S S Quintans; Lucindo J Quintans-Junior; Valter J Santana-Filho; Cláudio Leinig Pereira da Cunha; Igor Alexandre Cortes Menezes; Márcio R Viana Santos Journal: Braz J Anesthesiol Date: 2019-12-09