Meta-Analysis of the Prognostic Value of Skin Perfusion Parameters in Sepsis Patients: Evidence Integration Based on
Li Juan Shi1,2, Shu Fen Ke3, Li Mei Zhu3
1School of Nursing, Putian University, Putian, China.
Background:
Despite advances in intensive care, sepsis and septic shock still have high morbidity and mortality. Microcirculatory disturbance is a key issue in sepsis, leading to hypoperfusion, hypoxia, and organ failure. The skin is a sensitive indicator of microcirculatory changes and often shows early systemic changes. Recently, bedside skin perfusion indicators such as the mottling score (MS), capillary refill time (CRT), and peripheral perfusion index (PPI) have become common in practice. However, their value in predicting outcomes lacks strong evidence.
Methods:
A systematic search was conducted across databases, including PubMed, Web of Science, Cochrane Library, EBSCO, China National Knowledge Infrastructure, Wanfang, and VIP, with a search period spanning from the inception of the databases to January 2026. Cohort studies or case-control studies investigating the correlation between skin perfusion parameters and the prognosis of sepsis patients (primary outcomes: 28-day mortality, 14-day mortality, and in-hospital mortality) were included. Two researchers independently performed literature screening, data extraction, and assessment of the Newcastle-Ottawa Scale (NOS) bias risk. A meta-analysis was performed using RevMan 5.4.1 software.
Results:
This study included a total of 22 articles, encompassing 2,727 study subjects. The meta-analysis results demonstrated that: 1) MS was significantly associated with 28-day mortality [odds ratio (OR) = 2.27, 95% confidence interval (CI): 1.79-2.87, P < 0.001] and 14-day mortality (OR = 1.96, 95% CI: 1.32-2.91, P < 0.001); 2) prolonged CRT duration was significantly associated with 28-day mortality (OR = 3.29, 95% CI: 2.08-5.21, P < 0.001) and in-hospital mortality (OR = 2.46, 95% CI: 1.18-5.12, P < 0.001); 3) reduced PPI was significantly associated with 28-day mortality (OR = 5.05, 95% CI: 3.65-6.98, P < 0.001) and in-hospital mortality (OR = 4.56, 95% CI: 3.32-6.26, P < 0.001). Sensitivity analysis confirmed robust results with no significant publication bias.
Conclusion:
The MS, CRT, and PPI, as bedside and noninvasive skin perfusion parameters, demonstrate significant predictive value for mortality risk in sepsis patients. Integrating these indicators facilitates early clinical identification of high-risk patients, guiding risk stratification, and resuscitation therapy. Future large-sample prospective studies are required to further standardize their assessment protocols and intervention thresholds.