Skin Mottling Associated In Increased Mortality In ICU Patients

MedicalResearch.com Interview with:
Rémi Coudroy MD
CHU de Poitiers, Service de Réanimation Médicale
CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France

Medical Research: What is the background for this study? What are the main findings?

Dr. Coudroy: Skin mottling is characterized by a red-violaceous discoloration of the skin. Its occurrence, as impaired consciousness and decreased urinary output are well-known clinical signs of shock. Skin mottling has been investigated only in patients with septic shock and recent studies have found that the extent and the persistence of skin mottling for more than 6 hours were associated with mortality. However, in daily clinical practice, we noticed that skin mottling occurred in patients without septic shock, and there was no data supporting the impact of skin mottling on the prognosis of critically ill patients.

In a retrospective monocentric observational study over a 1-year period in a 15-bed tertiary medical ICU where skin mottling over the knees is assessed by nurses, we found that skin mottling occurred in 29% of patients admitted to ICU. Nurses’ evaluation of skin mottling was highly reliable. In 60% of cases, mean arterial pressure was ≥ 65 mmHg without vasopressors. The occurrence of skin mottling was associated with mortality independently from calculated severity scores at admission (i.e. Simplified Acute Physiology Score II). Similarly, the persistence of skin mottling for more than 6 hours was associated with mortality independently from organ failure at the onset of skin mottling (i.e. the use of vasopressors, the need for mechanical ventilation and hyperlactatemia).

Medical Research: What should clinicians and patients take away from your report?

Dr. Coudroy: Skin mottling is an easy to assess clinical sign. Clinicians should be aware that skin mottling occurs frequently, mainly in patients without hypotension, and that its occurrence and its persistence for more than 6 hours can be considered as severity signs. We believe that systematic and serial assessment of skin mottling should be encouraged.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Coudroy: Pathophysiology of skin mottling is actually unknown. A better understanding of factors associated with skin mottling may lead to improve of critically ill patients’ management.

Citation:

Is skin mottling a predictor of high mortality in non-selected patients with cirrhosis admitted to intensive care unit?

Coudroy, Rémi et al.

Journal of Hepatology
DOI: http://dx.doi.org/10.1016/j.jhep.2015.05.025

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