PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
PURPOSE: 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 illpatients admitted in ICU and its role on their outcome. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: H Ait-Oufella; N Bige; P Y Boelle; C Pichereau; M Alves; R Bertinchamp; J L Baudel; A Galbois; E Maury; B Guidet Journal: Intensive Care Med Date: 2014-05-09 Impact factor: 17.440
Authors: Peter E Spronk; Can Ince; Martin J Gardien; Keshen R Mathura; Heleen M Oudemans-van Straaten; Durk F Zandstra Journal: Lancet Date: 2002-11-02 Impact factor: 79.321
Authors: Glenn Hernandez; Cesar Pedreros; Enrique Veas; Alejandro Bruhn; Carlos Romero; Maximiliano Rovegno; Rodolfo Neira; Sebastian Bravo; Ricardo Castro; Eduardo Kattan; Can Ince Journal: J Crit Care Date: 2011-07-27 Impact factor: 3.425
Authors: Aurélie Thooft; Raphaël Favory; Diamantino Ribeiro Salgado; Fabio S Taccone; Katia Donadello; Daniel De Backer; Jacques Creteur; Jean-Louis Vincent Journal: Crit Care Date: 2011-09-21 Impact factor: 9.097
Authors: Alexandre Lima; Michel E van Genderen; Jasper van Bommel; Eva Klijn; Tim Jansem; Jan Bakker Journal: Crit Care Date: 2014-06-19 Impact factor: 9.097
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: Daniel De Backer; Jan Bakker; Maurizio Cecconi; Ludhmila Hajjar; Da Wei Liu; Suzanna Lobo; Xavier Monnet; Andrea Morelli; Sheila Neinan Myatra; Azriel Perel; Michael R Pinsky; Bernd Saugel; Jean-Louis Teboul; Antoine Vieillard-Baron; Jean-Louis Vincent Journal: Intensive Care Med Date: 2018-05-03 Impact factor: 17.440
Authors: Bart Hiemstra; Ruben J Eck; Geert Koster; Jørn Wetterslev; Anders Perner; Ville Pettilä; Harold Snieder; Yoran M Hummel; Renske Wiersema; Anne Marie G A de Smet; Frederik Keus; Iwan C C van der Horst Journal: BMJ Open Date: 2017-09-27 Impact factor: 2.692