Observational studyCritical care (London, England)2017
Marked regional endothelial dysfunction in mottled skin area in patients with severe infections.
Observational study in Critical care (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Meta-Analysis of the Prognostic Value of Skin Perfusion Parameters in Sepsis Patients: Evidence Integration Based on the Mottling Score, Capillary Refill Time, and Peripheral Perfusion Index.Shock (Augusta, Ga.) · 2026Pooled it
- Resuscitation-associated endotheliopathy (RAsE): a conceptual framework based on a systematic review and meta-analysis.Systematic reviews · 2023Pooled it
- Protocolised early de-resuscitation in septic shock (REDUCE): protocol for a randomised controlled multicentre feasibility trial.BMJ open · 2023Article
- Mottling as a prognosis marker in cardiogenic shock.Annals of intensive care · 2023Article
- Modifications of peripheral perfusion in patients with vasopressor-dependent septic shock treated with polymyxin B-direct hemoperfusion.Scientific reports · 2023Observational
- Reversible skin microvascular hyporeactivity in patients with immune-mediated thrombocytopenic thrombotic purpura.Critical care (London, England) · 2023Observational
- Vitamin C improves microvascular reactivity and peripheral tissue perfusion in septic shock patients.Critical care (London, England) · 2022Article
- Case report: Temporal alterations in vascular function during the first 2 weeks of pediatric septic shock.Frontiers in pediatrics · 2022Article
- Dynamic tracking of microvascular hemoglobin content for continuous perfusion monitoring in the intensive care unit: pilot feasibility study.Journal of clinical monitoring and computing · 2021Observational
- Review
- When data interpretation should not rely on the magnitude of P values: the example of ANDROMEDA SHOCK trial.Annals of translational medicine · 2020Article
- Assessment of sublingual microcirculation in critically ill patients: consensus and debate.Annals of translational medicine · 2020Review
- Dermatological Manifestations in the Intensive Care Unit: A Practical Approach.Critical care research and practice · 2020Review
- Contribution of Capillary Refilling Time and Skin Mottling Score to Predict ICU Admission of Patients with Septic or haemorrhagic Shock Admitted to the Emergency Department: A TRCMARBSAU Study.Turkish journal of anaesthesiology and reanimation · 2019Article
- Relationship of mottling score, skin microcirculatory perfusion indices and biomarkers of endothelial dysfunction in patients with septic shock: an observational study.Critical care (London, England) · 2019Observational
- Exploring the microvascular impact of red blood cell transfusion in intensive care unit patients.Critical care (London, England) · 2019Observational
- Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters.Critical care (London, England) · 2019Article
- Narrative review: clinical assessment of peripheral tissue perfusion in septic shock.Annals of intensive care · 2019Review
- Impaired vascular reactivity in sepsis - a systematic review with meta-analysis.Archives of medical sciences. Atherosclerotic diseases · 2019Article
- Albumin infusion improves endothelial function in septic shock patients: a pilot study.Intensive care medicine · 2018Article
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMottling around the knee, reflecting a reduced skin blood flow, is predictive of mortality in patients with septic shock. However, the causative pathophysiology of mottling remains unknown. We hypothesized that the cutaneous hypoperfusion observed in the mottled area is related to regional endothelial dysfunction.
methodsThis was a prospective, observational study in a medical ICU in a tertiary teaching hospital. Consecutive adult patients with sepsis admitted to ICU were included. After resuscitation, endothelium-dependent vasodilation in the skin circulation was measured before and after iontophoresis of acetylcholine (Ach) in the forearm and the knee area. We analyzed the patterns of induced vasodilatation according to the presence or absence of mottling and vital status at 14 days.
resultsWe evaluated 37 septic patients, including 11 without and 26 with septic shock. Overall 14-day mortality was 22%. Ten patients had mottling around the knee (10/37, 27%). In the knee area, the increased skin blood flow following iontophoresis of Ach was lower in patients with mottled skin as compared to patients without mottled skin (area under curve (AUC) 3280 (2643-6440) vs. 7980 (4233-19,707), both P < 0.05). In the forearm area, the increased skin blood flow following iontophoresis of Ach was similar in patients with and without mottled skin. Among patients with septic shock, the increased skin blood flow following iontophoresis of Ach in the knee area was significantly lower in non-survivors as compared to survivors at 14 days (AUC 3256 (2600-4426) vs. 7704 (4539-15,011), P < 0.01). In patients with septic shock, the increased skin blood flow in the forearm area following iontophoresis of Ach was similar in survivors and non-survivors at 14 days.
conclusionMottling is associated with regional endothelial dysfunction in patients with septic shock. Endothelial dysfunction in the knee skin area was more pronounced in non-survivors than in survivors.
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