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. 2023 Sep 6;13(1):80.
doi: 10.1186/s13613-023-01175-0.

Mottling as a prognosis marker in cardiogenic shock

Hamid Merdji  1 , Vincent Bataille  2 , Anais Curtiaud  1 , Laurent Bonello  3   4   5 , François Roubille  6 , Bruno Levy  7 , Pascal Lim  8   9 , Francis Schneider  10 , Hadi Khachab  11   12 , Jean-Claude Dib  13 , Marie-France Seronde  14 , Guillaume Schurtz  15 , Brahim Harbaoui  16   17 , Gerald Vanzetto  18 , Severine Marchand  19 , Caroline Eva Gebhard  20 , Patrick Henry  21 , Nicolas Combaret  22 , Benjamin Marchandot  23 , Benoit Lattuca  24 , Caroline Biendel  25   26 , Guillaume Leurent  27 , Edouard Gerbaud  28   29 , Etienne Puymirat  30   31 , Eric Bonnefoy  32 , Ferhat Meziani  1 , Clément Delmas  33   34
Affiliations

Mottling as a prognosis marker in cardiogenic shock

Hamid Merdji et al. Ann Intensive Care. .

Abstract

Aims: Impact of skin mottling has been poorly studied in patients admitted for cardiogenic shock. This study aimed to address this issue and identify determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all etiologies.

Methods and results: FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October, 2016. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 660 had skin mottling assessed at admission (85.5%) with almost 39% of patients in cardiogenic shock presenting mottling. The need for invasive respiratory support was significantly higher in patients with mottling (50.2% vs. 30.1%, p < 0.001) and likewise for the need for renal replacement therapy (19.9% vs. 12.4%, p = 0.09). However, the need for mechanical circulatory support was similar in both groups. Patients with mottling at admission presented a higher length of stay (19 vs. 16 days, p = 0.033), a higher 30-day mortality rate (31% vs. 23.3%, p = 0.031), and also showed significantly higher mortality at 1-year (54% vs. 42%, p = 0.003). The subgroup of patients in whom mottling appeared during the first 24 h after admission had the worst prognosis at 30 days.

Conclusion: Skin mottling at admission in patients with cardiogenic shock was statistically associated with prolonged length of stay and poor outcomes. As a perfusion-targeted resuscitation parameter, mottling is a simple, clinical-based approach and may thus help to improve and guide immediate goal-directed therapy to improve cardiogenic shock patients' outcomes.

Keywords: Acute heart failure; Cardiogenic shock; Microcirculation; Perfusion.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curve showing early and long-term mortality in cardiogenic shock according to the presence of mottling at admission
Fig. 2
Fig. 2
Kaplan–Meier curve showing early and long-term mortality in cardiogenic shock in the subgroup of patients who were still alive after 24 h, according to the presence of mottling at admission and its evolution at 24 h. Survival in the subgroup of patients who were still alive after 24 h according to the presence of mottling at admission and its evolution at 24 h. The “No mottling” group corresponds to patients without mottling at admission or at 24 h. The “mottling disappearance” corresponds to patients with mottling at admission that disappears at 24 h. The “mottling appearance” group corresponds to patients without mottling at admission in which mottling appears at 24 h. The “mottling persistence” group corresponds to patients with mottling at admission and mottling persistence at 24 h
Fig. 3
Fig. 3
Forest plot of factors at admission associated with 30-day mortality in patients with mottling—multivariate analysis 30-day mortality
See this image and copyright information in PMC

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