Related Experiment Video
Updated: Aug 1, 2026
A Contemporary Warming/Restraining Device for Efficient Tail Vein Injections in a Murine Fungal Sepsis Model
Published on: November 6, 2020
Mottling score predicts survival in septic shock
H Ait-Oufella1, S Lemoinne, P Y Boelle
1Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris Cedex 12, France. hafid.aitoufella@sat.aphp.fr
Background:
Experimental and clinical studies have identified a crucial role of microcirculation impairment in severe infections. We hypothesized that mottling, a sign of microcirculation alterations, was correlated to survival during septic shock.
Methods:
We conducted a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included during a 7-month period. After initial resuscitation, we recorded hemodynamic parameters and analyzed their predictive value on mortality. The mottling score (from 0 to 5), based on mottling area extension from the knees to the periphery, was very reproducible, with an excellent agreement between independent observers [kappa = 0.87, 95% CI (0.72-0.97)].
Results:
Sixty patients were included. The SOFA score was 11.5 (8.5-14.5), SAPS II was 59 (45-71) and the 14-day mortality rate 45% [95% CI (33-58)]. Six hours after inclusion, oliguria [OR 10.8 95% CI (2.9, 52.8), p = 0.001], arterial lactate level [<1.5 OR 1; between 1.5 and 3 OR 3.8 (0.7-29.5); >3 OR 9.6 (2.1-70.6), p = 0.01] and mottling score [score 0-1 OR 1; score 2-3 OR 16, 95% CI (4-81); score 4-5 OR 74, 95% CI (11-1,568), p < 0.0001] were strongly associated with 14-day mortality, whereas the mean arterial pressure, central venous pressure and cardiac index were not. The higher the mottling score was, the earlier death occurred (p < 0.0001). Patients whose mottling score decreased during the resuscitation period had a better prognosis (14-day mortality 77 vs. 12%, p = 0.0005).
Conclusion:
The mottling score is reproducible and easy to evaluate at the bedside. The mottling score as well as its variation during resuscitation is a strong predictor of 14-day survival in patients with septic shock.
Insights
The mottling score, a bedside assessment of skin discoloration, accurately predicts survival in patients with septic shock. A decreasing score during treatment indicates a better prognosis and improved survival rates.
Area of Science:
- Critical Care Medicine
- Microcirculation Research
- Sepsis Pathophysiology
Background:
- Microcirculation impairment is critical in severe infections like septic shock.
- Mottling, a visible sign of altered microcirculation, was investigated for its correlation with survival.
Purpose of the Study:
- To evaluate the prognostic value of the mottling score in patients with septic shock.
- To determine if mottling score variations during resuscitation predict survival.
Main Methods:
- A prospective observational study included consecutive septic shock patients over 7 months.
- The reproducible mottling score (0-5) was assessed, along with hemodynamic parameters.
- Predictive value of mottling score and variations on 14-day mortality was analyzed.
Main Results:
- Mottling score, oliguria, and arterial lactate levels strongly predicted 14-day mortality.
- Higher mottling scores correlated with earlier death.
- A decrease in mottling score during resuscitation significantly improved 14-day survival (12% vs. 77%).
Conclusions:
- The mottling score is a reproducible and easily applicable bedside tool.
- Both the mottling score and its change during resuscitation are powerful predictors of 14-day survival in septic shock.
