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Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other
Guillaume Dumas1,2,3, Jean-Rémi Lavillegrand4,5, Jérémie Joffre4
1Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris, cedex 12, France. dumas.guillaume1@gmail.com.
Background:
Mottling score, a tissue perfusion parameter, is correlated with outcome in septic shock patients. However, its predictive value on mortality according to prognostic covariates such as vasopressor dose and other tissue perfusion parameters remains unknown.
Methods:
Mottling score and tissue perfusion parameters were recorded at ICU admission (H0), H-6, H 12, and H-24 and used to assess the predictive value of mottling score on 14-day mortality in a development cohort. Results were then validated in an independent cohort of septic shock patients in Brazil.
Results:
Overall, 259 patients with sepsis or septic shock were included, 14-day mortality was 37%. Factors associated with death were mottling score (OR 2.26 [95% CI, 1.72-2.97]), arterial lactate level (OR 1.29 [1.11-1.5]), and urine output < 0.5 ml/Kg/h (OR 3.03 [1.37-6.69]). The C statistic for the model was 0.90 in the development cohort and 0.76 in the validation cohort. The predictive value of mottling score was not affected by vasopressor doses (p for interaction = 0.33): OR for mottling score ranged from 2.34 [1.10-3.15] in patients without vasopressor to 3.84 [1.98-7.43] in patients infused with high doses of vasopressor (> 0.8 μg/kg/min). There was no difference in the effect of mottling score on mortality according to mean arterial pressure, heart rate, cardiac index, and urine output, but we found a significant interaction between arterial lactate level and mottling score (p = 0.04). The predictive value of the mottling score remains significant when using the recent SEPSIS-3 definition of septic shock. Finally, a decrease of mottling score during resuscitation was significantly associated with better outcome after adjustment on SOFA score (p = 0.001).
Conclusions:
Our results support the high prognostic value of mottling score for 14-day mortality in septic patients, whatever vasopressor dosage and other perfusion parameters. Mottling score variations during resuscitation are also predictive of mortality.
Insights
Mottling score accurately predicts 14-day mortality in septic shock patients, regardless of vasopressor dose or other perfusion parameters. Changes in mottling score during resuscitation also indicate patient outcomes.
Area of Science:
- Critical Care Medicine
- Sepsis Pathophysiology
- Prognostic Biomarkers
Background:
- Mottling score is a recognized indicator of tissue perfusion in septic shock.
- Its precise predictive value for mortality, considering factors like vasopressor use and other perfusion metrics, requires further elucidation.
Purpose of the Study:
- To evaluate the prognostic value of mottling score for 14-day mortality in septic shock patients.
- To determine if this predictive value is influenced by vasopressor dosage and other key perfusion parameters.
Main Methods:
- Mottling score and tissue perfusion parameters were recorded at multiple time points (H0, H-6, H-12, H-24) in a development cohort.
- The predictive accuracy of mottling score for 14-day mortality was assessed and validated in an independent Brazilian cohort.
Main Results:
- Mottling score, arterial lactate, and low urine output were significant predictors of 14-day mortality.
- The predictive value of mottling score was consistent across varying vasopressor doses and independent of mean arterial pressure, heart rate, cardiac index, and urine output.
- A significant interaction was noted between arterial lactate and mottling score (p=0.04).
Conclusions:
- Mottling score demonstrates robust prognostic value for 14-day mortality in septic patients, irrespective of vasopressor support or other perfusion parameters.
- Monitoring mottling score changes during resuscitation provides additional predictive information regarding patient outcomes.
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