Observational studyCritical care (London, England)2019
Relationship of mottling score, skin microcirculatory perfusion indices and biomarkers of endothelial dysfunction in patients with septic shock: an observational study.
Observational study in Critical care (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- 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
- Medical hyperspectral imaging: an updated review of technology advancements and biomedical applications.Journal of biomedical optics · 2026Pooled it
- Beyond macrocirculatory targets: a multimodal framework for microcirculatory and organ perfusion monitoring in sepsis.Critical care (London, England) · 2026Review
- ARISE framework: a temporal, multi-organ view of perfusion in sepsis.Internal and emergency medicine · 2026Review
- High vasopressor doses are associated with decreased tissue oxygenation in critically ill patients: a secondary analysis of a prospective cohort.Critical care (London, England) · 2026Article
- Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study.Clinical and experimental emergency medicine · 2026Article
- Microcirculation Monitoring in Septic Shock: Focused Review.Medicina (Kaunas, Lithuania) · 2026Review
- Lactate in cardiogenic shock: pathophysiology, prognostic value, and clinical interpretation.Annals of intensive care · 2026Review
- Article
- The value of proportion of perfused vessels change rate in the evaluation of early organ function deterioration in septic shock and ARDS.Frontiers in medicine · 2026Article
- Expert consensus statement on the evaluation, treatment, and transfer of cardiogenic shock using a Delphi method approach: a report of the Japan Critical Care Cardiology Committee (J4 CS).Journal of intensive care · 2025Article
- AI-powered skin spectral imaging enables instant sepsis diagnosis and outcome prediction in critically ill patients.Science advances · 2025Observational
- Relationship between inflammatory factors, lactic acid levels, acute skin failure, bad mood, and sleep quality.World journal of psychiatry · 2025Article
- Exploration of oral microbiota alteration and AI-driven non-invasive hyperspectral imaging for CAD prediction.BMC cardiovascular disorders · 2025Article
- Acute skin failure knowledge, attitudes and practices amongst intensive care unit nurses in China: A multicentre cross-sectional survey.International wound journal · 2025Article
- ICAM1 and VCAM1 are associated with outcome in patients with sepsis: A systematic review and meta-analysis.Heliyon · 2024Article
- Angiopoietin-2 as a prognostic biomarker in septic adult patients: a systemic review and meta-analysis.Annals of intensive care · 2024Review
- Construction and validation of a clinical prediction model for sepsis using peripheral perfusion index to predict in-hospital and 28-day mortality risk.Scientific reports · 2024Article
- Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges.Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2024Article
- A proof of concept for microcirculation monitoring using machine learning based hyperspectral imaging in critically ill patients: a monocentric observational study.Critical care (London, England) · 2024Observational
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Authors and funding
6 authors.
Funding
Abstract
backgroundIn patients with septic shock, the skin is often chosen for the evaluation of peripheral perfusion and oxygenation. Changes in skin microcirculatory vessel oxygen saturation and relative hemoglobin concentration can be described using a mottling score or captured with hyperspectral imaging. However, the effectiveness of the mottling score in assessing microcirculation remains to be shown. We hypothesize that the mottling score in patients with septic shock is related to skin microcirculatory perfusion indices quantified by hyperspectral imaging, biomarkers that reflect endothelium activation and damage, and clinical outcome.
methodsHyperspectral imaging of the knee area was performed in 95 intensive care patients with septic shock enrolled in a single-center observational study to obtain relative oxy/deoxyhemoglobin concentration values and construct anatomical maps of skin microcirculatory saturation. The blood was sampled to obtain concentrations of thrombomodulin, plasminogen activator inhibitor-1 (PAI-1), soluble intercellular adhesion molecule-1 (ICAM-1), soluble vascular cell adhesion molecule-1 (VCAM-1), angiopoietin-2, and syndecan-1. The spectrophotometrically obtained skin microvascular perfusion indices were compared to the mottling score and biomarker concentration. The association between mottling score, skin microcirculatory perfusion indices, and 28-day mortality was also analyzed.
resultsMicrocirculatory oxygen saturation was significantly lower and total hemoglobin concentration was significantly higher in patients with a mottling score of 2 compared to those with a score of 0 (p = 0.02), with no difference between other scores. We found an association between microcirculatory oxygen saturation and PAI-1 levels (rho = - 0.3; p = 0.007). Increased mottling score and decreased microcirculatory oxygen saturation were predictive of 28-day mortality (mottling score 2 vs 0: OR 15.31, 95% CI 4.12-68.11; microcirculatory oxygen saturation: OR 0.90, 95% CI 0.85-0.95). Endothelial biomarkers did not increase the predictive value of skin microcirculatory perfusion indices.
conclusionsHigher mottling scores are associated with lower microcirculatory oxygen saturation but with significant overlap between scores. Microcirculatory oxygen saturation is a quantitative measure of peripheral oxygenation and is more specific than the mottling score in predicting 28-day mortality.
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