Marked regional endothelial dysfunction in mottled skin area in patients with severe infections
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 t...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-06-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1742-x |
| _version_ | 1818274732878856192 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Simon Bourcier |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-12T22:18:32Z |
| format | Article |
| id | doaj.art-d470c646d2274533817af880b10e59a5 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-12T22:18:32Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-d470c646d2274533817af880b10e59a52022-12-22T00:10:01ZengBMCCritical Care1364-85352017-06-012111810.1186/s13054-017-1742-xMarked regional endothelial dysfunction in mottled skin area in patients with severe infectionsSimon Bourcier0Jérémie Joffre1Vincent Dubée2Gabriel Preda3Jean-Luc Baudel4Naïke Bigé5Guillaume Leblanc6Bernard I. Levy7Bertrand Guidet8Eric Maury9Hafid Ait-Oufella10Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleInserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC)Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAbstract 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.http://link.springer.com/article/10.1186/s13054-017-1742-xInfectionMottlingTissue perfusionMortalityEndothelial function |
| spellingShingle | 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 Marked regional endothelial dysfunction in mottled skin area in patients with severe infections Critical Care Infection Mottling Tissue perfusion Mortality Endothelial function |
| title | Marked regional endothelial dysfunction in mottled skin area in patients with severe infections |
| title_full | Marked regional endothelial dysfunction in mottled skin area in patients with severe infections |
| title_fullStr | Marked regional endothelial dysfunction in mottled skin area in patients with severe infections |
| title_full_unstemmed | Marked regional endothelial dysfunction in mottled skin area in patients with severe infections |
| title_short | Marked regional endothelial dysfunction in mottled skin area in patients with severe infections |
| title_sort | marked regional endothelial dysfunction in mottled skin area in patients with severe infections |
| topic | Infection Mottling Tissue perfusion Mortality Endothelial function |
| url | http://link.springer.com/article/10.1186/s13054-017-1742-x |
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