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Article Dans Une Revue Annals of Intensive Care Année : 2023

Mottling as a prognosis marker in cardiogenic shock

Francis Schneider
  • Fonction : Auteur
Hadi Khachab
  • Fonction : Auteur
Jean-Claude Dib
  • Fonction : Auteur
Marie-France Seronde
  • Fonction : Auteur
Gerald Vanzetto
  • Fonction : Auteur
Severine Marchand
  • Fonction : Auteur
Caroline Eva Gebhard
  • Fonction : Auteur
Patrick Henry
  • Fonction : Auteur
Nicolas Combaret
  • Fonction : Auteur
Benjamin Marchandot
  • Fonction : Auteur
Benoit Lattuca
  • Fonction : Auteur
Eric Bonnefoy
  • Fonction : Auteur
Ferhat Meziani
  • Fonction : Auteur
Clément Delmas

Résumé

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.
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Origine : Publication financée par une institution
Licence : CC BY - Paternité

Dates et versions

hal-04205713 , version 1 (17-09-2023)
hal-04205713 , version 2 (11-10-2023)

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Hamid Merdji, Vincent Bataille, Anais Curtiaud, Laurent Bonello, François Roubille, et al.. Mottling as a prognosis marker in cardiogenic shock. Annals of Intensive Care, 2023, 13 (1), pp.80. ⟨10.1186/s13613-023-01175-0⟩. ⟨hal-04205713v2⟩
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