ArticleCritical care (London, England)2019
Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters.
Article in Critical care (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04693923 (Capillary Refill Time Response to a Rapid Fluid Challenge in Septic Shock Patients), which is not on this map. Cited by 38 papers, 1 of them a synthesis 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.
The trial behind it
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.
Capillary Refill Time Response to a Rapid Fluid Challenge in Septic Shock Patients: Pathophysiological Determinants, and Relation to Changes in Systemic, Regional and Microcirculatory Blood Flow
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 108 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
- Beyond macrocirculatory targets: a multimodal framework for microcirculatory and organ perfusion monitoring in sepsis.Critical care (London, England) · 2026Review
- The usual suspects: a pragmatic framework to identify and address reversible contributors in apparent refractory septic shock.Critical care (London, England) · 2026Review
- Microcirculation and Cerebrovascular Autoregulation in Patients With Mechanical Circulatory Support Devices.Journal of stroke · 2026Review
- The Importance of Plasma Renin Concentrations in Intensive Care Patients with Circulatory Shock.Journal of clinical medicine · 2026Article
- Less-Invasive Hemodynamic and Tissue Perfusion Monitoring in Sepsis and Septic Shock: A Narrative Review.Journal of clinical medicine · 2026Review
- Resuscitation Targets, Fluids, and Vasoactives in Septic Shock.Clinics in chest medicine · 2026Review
- Microcirculation Monitoring in Septic Shock: Focused Review.Medicina (Kaunas, Lithuania) · 2026Review
- Electrochemical skin conductance is associated with peripheral tissue hypoperfusion in septic patients.Intensive care medicine experimental · 2025Article
- Dobutamine administration: a proposal for a standardized approach.Intensive care medicine experimental · 2025Article
- Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation.Journal of personalized medicine · 2025Review
- Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method.Intensive care medicine · 2025Review
- Mottling as an Early Sign of Euglycemic Ketoacidosis Induced by SGLT-2 Inhibitors.European journal of case reports in internal medicine · 2025Article
- Deleting fibroblast growth factor 2 in macrophages aggravates septic acute lung injury by increasing M1 polarization and inflammatory cytokine secretion.Molecular biomedicine · 2024Article
- Early peripheral perfusion monitoring in septic shock.European journal of medical research · 2024Review
- [Intraoperative clinical application of hemodynamic monitoring in noncardiac surgery patients].Die Anaesthesiologie · 2024Review
- Mortality predictors in patients with suspected sepsis in the emergency department of a tertiary care hospital: a retrospective cohort study.International journal of emergency medicine · 2024Article
- Skin mottling score assesses peripheral tissue hypoperfusion in critically ill patients following cardiac surgery.BMC anesthesiology · 2024Article
- Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis.Biomedicines · 2024Review
- Mottling in Septic Shock: Ethnicity and Skin Color Matter.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMottling 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.
methodsMottling 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.
resultsOverall, 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).
conclusionsOur 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.
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