Mottling score in sepsis and İTS relation with mortality

Aim: In patients diagnosed with sepsis or septic shock, the relationship between the mottling score, which is defined as abnormal skin mottling in the knee area, which is one of the physical examination findings showing microcirculation, and the mortality of the patients was investigated. Material and Method: 92 patients who were admitted to the intensive care units of our department due to sepsis or septic shock (sepsis was diagnosed according to international consensus reports), or who were diagnosed with sepsis or septic shock while he was hospitalized in the intensive care unit for another reason were included in our prospective observational study. Age, height, weight, body mass index, indication for intensive care unit admission, source of sepsis and comorbidities of the patients included in the study were recorded. Patients' heart rate, mean arterial pressure, body temperature, capillary refill time, mottling score, arterial lactate level, hemoglobin level, hourly urine output, central venous pressure, central venous oxygen saturation (ScvO2), arteriovenous oxygen concentration difference (C[a-v) ]O2), venous-arterial carbon dioxide partial pressure difference (∆PCO2), if used, the name of the vasopressor/inotropic agent and the amount of infusion were measured at 6-hour intervals for a total of 24 hours. SAPS 2 and SOFA scores were calculated to evaluate the prognosis of patients in terms of survival. Survival of the patients was recorded as of the 14th day after diagnosis. Results: Of the 92 patients in our study, 64 (69%) died within a 14-day period. The mottling score was significantly different between the deceased group and the survivors at all measurement times (T0; p= 0.002, T6; p= <0.001, T12; p= <0.001, T18; p= 0.001, T24; p= 0.009) It was observed that mortality increased at all times with the increase in mottling score (Score 0-1/Score 2-3/Score 4-5) (T0; p=0.032, T6; 0.008, T12; 0.027, T18; p= 0.012, T24; p= 0.031). Mortality was found to be higher in patients with a mottling score within a 24-hour period compared to patients without a mottling score (89% versus 54%, p= <0.001). Conclusion: Septic shock affects the microcirculation, leading to organ failure and mortality. Monitoring the microcirculatory findings has prognostic importance in septic shock. The data we obtained in our study suggested that increasing levels of mottling score, which is a marker of microcirculation at any stage of diagnosis or resuscitation, can be used as a warning sign for increased mortality.