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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Marked regional endothelial dysfunction in mottled skin area in patients with severe infections

Authors: Simon Bourcier, Jérémie Joffre, Vincent Dubée, Gabriel Preda, Jean-Luc Baudel, Naïke Bigé, Guillaume Leblanc, Bernard I. Levy, Bertrand Guidet, Eric Maury, Hafid Ait-Oufella

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Mottling around the knee, reflecting a reduced skin blood flow, is predictive of mortality in patients with septic shock. However, the causative pathophysiology of mottling remains unknown. We hypothesized that the cutaneous hypoperfusion observed in the mottled area is related to regional endothelial dysfunction.

Methods

This was a prospective, observational study in a medical ICU in a tertiary teaching hospital. Consecutive adult patients with sepsis admitted to ICU were included. After resuscitation, endothelium-dependent vasodilation in the skin circulation was measured before and after iontophoresis of acetylcholine (Ach) in the forearm and the knee area. We analyzed the patterns of induced vasodilatation according to the presence or absence of mottling and vital status at 14 days.

Results

We evaluated 37 septic patients, including 11 without and 26 with septic shock. Overall 14-day mortality was 22%. Ten patients had mottling around the knee (10/37, 27%). In the knee area, the increased skin blood flow following iontophoresis of Ach was lower in patients with mottled skin as compared to patients without mottled skin (area under curve (AUC) 3280 (2643–6440) vs. 7980 (4233–19,707), both P < 0.05). In the forearm area, the increased skin blood flow following iontophoresis of Ach was similar in patients with and without mottled skin. Among patients with septic shock, the increased skin blood flow following iontophoresis of Ach in the knee area was significantly lower in non-survivors as compared to survivors at 14 days (AUC 3256 (2600–4426) vs. 7704 (4539–15,011), P < 0.01). In patients with septic shock, the increased skin blood flow in the forearm area following iontophoresis of Ach was similar in survivors and non-survivors at 14 days.

Conclusion

Mottling is associated with regional endothelial dysfunction in patients with septic shock. Endothelial dysfunction in the knee skin area was more pronounced in non-survivors than in survivors.
Appendix
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Metadata
Title
Marked regional endothelial dysfunction in mottled skin area in patients with severe infections
Authors
Simon Bourcier
Jérémie Joffre
Vincent Dubée
Gabriel Preda
Jean-Luc Baudel
Naïke Bigé
Guillaume Leblanc
Bernard I. Levy
Bertrand Guidet
Eric Maury
Hafid Ait-Oufella
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1742-x

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