Mottling as a prognosis marker in cardiogenic shock
Hamid Merdji, Vincent Bataille, Anaïs Curtiaud, Laurent Bonello, François Roubille, Bruno Lévy, Pascal Lim, Francis Schneider, Hadi Khachab, Jean-Claude Dib, Marie‐France Seronde, Guillaume Schurtz, Brahim Harbaoui, Gérald Vanzetto, S Marchand, Caroline E. Gebhard, Patrick Henry, Nicolas Combaret, Benjamin Marchandot, Benoît Lattuca, Caroline Biendel, Guillaume Leurent, Édouard Gerbaud, Étienne Puymirat, Éric Bonnefoy, Ferhat Meziani, Clément Delmas
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.