Mottling as a prognosis marker in cardiogenic shock
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Published:2023-09-06
Issue:1
Volume:13
Page:
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ISSN:2110-5820
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Container-title:Annals of Intensive Care
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language:en
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Short-container-title:Ann. Intensive Care
Author:
Merdji Hamid, Bataille Vincent, Curtiaud Anais, Bonello Laurent, Roubille François, Levy Bruno, Lim Pascal, Schneider Francis, Khachab Hadi, Dib Jean-Claude, Seronde Marie-France, Schurtz Guillaume, Harbaoui Brahim, Vanzetto Gerald, Marchand Severine, Gebhard Caroline Eva, Henry Patrick, Combaret Nicolas, Marchandot Benjamin, Lattuca Benoit, Biendel Caroline, Leurent Guillaume, Gerbaud Edouard, Puymirat Etienne, Bonnefoy Eric, Meziani Ferhat, Delmas ClémentORCID
Abstract
Abstract
Aims
Impact of skin mottling has been poorly studied in patients admitted for cardiogenic shock. This study aimed to address this issue and identify determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all etiologies.
Methods and results
FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October, 2016. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 660 had skin mottling assessed at admission (85.5%) with almost 39% of patients in cardiogenic shock presenting mottling. The need for invasive respiratory support was significantly higher in patients with mottling (50.2% vs. 30.1%, p < 0.001) and likewise for the need for renal replacement therapy (19.9% vs. 12.4%, p = 0.09). However, the need for mechanical circulatory support was similar in both groups. Patients with mottling at admission presented a higher length of stay (19 vs. 16 days, p = 0.033), a higher 30-day mortality rate (31% vs. 23.3%, p = 0.031), and also showed significantly higher mortality at 1-year (54% vs. 42%, p = 0.003). The subgroup of patients in whom mottling appeared during the first 24 h after admission had the worst prognosis at 30 days.
Conclusion
Skin mottling at admission in patients with cardiogenic shock was statistically associated with prolonged length of stay and poor outcomes. As a perfusion-targeted resuscitation parameter, mottling is a simple, clinical-based approach and may thus help to improve and guide immediate goal-directed therapy to improve cardiogenic shock patients’ outcomes.
Graphical Abstract
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference50 articles.
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