Ait-Oufella et al graded the level of mottling in the lower extremities of patients admitted with septic shock. This is a measure of microcirculatory dysfunction. The authors are from multiple hospitals in Paris.
Patient selection: septic shock
Outcome: 14-day mortality
Mottling of the lower extremities is evaluated on admission and after resuscitation 6 hours later.
Extent of Mottling in the Skin of the Lower Extremity |
Grade |
none |
0 |
coin-sized area in the center of the knee |
1 |
mottling in skin overlying the patella |
2 |
extends into distal half of the thigh |
3 |
extends into the proximal half of the thigh |
4 |
extends beyond the groin fold |
5 |
where:
• Mottling extends distal to the knee as well.
• Presumably the mottling is evaluated in both lower extremities.
Mottling Grade at 6 hr |
Odds Ratio Mortality |
0 or 1 |
1 |
2 or 3 |
16 |
4 or 5 |
74 |
A drop in the mottling grade during the resuscitation period was associated with a better prognosis. A rise in the mottling grade was associated with a poor prognosis.
Other parameters measured at 6 hours after admission associated with 14-day mortality:
(1) arterial lactate in mmol/L (high risk if > 3, moderate risk if >= 1.5)
(2) urine output < 0.5 mL per kg per hour
Specialty: Critical Care, Emergency Medicine, Infectious Diseases
ICD-10: ,