Service de Réanimation Médicale, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France,
Intensive Care Med. 2015 Mar;41(3):452-9. doi: 10.1007/s00134-014-3600-5. Epub 2014 Dec 17.
Skin mottling is frequent and can be associated with an increased mortality rate in ICU patients with septic shock. Its overall incidence in ICU and its impact on outcome is unknown. We aimed to assess the incidence of skin mottling over the knee among all critically ill patients admitted in ICU and its role on their outcome.
An observational study over a 1-year period in a 15-bed medical ICU of a teaching hospital. Skin mottling over the knee was prospectively and qualitatively assessed by trained nurses.
Incidence of skin mottling was 29% (230 of 791 patients) in overall, and 49% (32 of 65 patients) in the subset of patients admitted for septic shock. Skin mottling was present on the day on admission in 65% of patients and persisted more than 6 h in 59% of cases. In-ICU mortality was 8% in patients without mottling, 30% in patients with short skin mottling and 40% in patients with persistent skin mottling (p < 0.01 between all groups). In the overall population, skin mottling over the knee was associated with in-ICU mortality independently from SAPS II (aOR 3.29 [95% CI, 2.08-5.19], p < 0.0001). Among patients with skin mottling over the knee, persistence of skin mottling remained associated with increased in-ICU mortality independently of organ dysfunctions at the mottling onset (OR 2.77 [95% CI, 1.34-5.72], p = 0.004).
Skin mottling is frequent in the general population of patients admitted in ICU. Occurrence and persistence of skin mottling are independently associated with in-ICU mortality.
皮肤斑点在感染性休克的 ICU 患者中很常见，并且与死亡率的增加有关。其在 ICU 中的总体发生率及其对预后的影响尚不清楚。我们旨在评估所有入住 ICU 的危重症患者中膝部皮肤斑点的发生率及其对预后的影响。
在一家教学医院的 15 张病床的内科 ICU 中进行了为期 1 年的观察性研究。经过培训的护士对膝部皮肤斑点进行了前瞻性和定性评估。
总体而言，皮肤斑点的发生率为 29%（791 例患者中有 230 例），而在因感染性休克入院的患者亚组中为 49%（65 例患者中有 32 例）。在入院当天，有 65%的患者出现皮肤斑点，59%的患者皮肤斑点持续超过 6 小时。无斑点的患者 ICU 死亡率为 8%，斑点持续时间短的患者为 30%，斑点持续时间长的患者为 40%（所有组之间差异均<0.01）。在总体人群中，膝部皮肤斑点与 ICU 死亡率独立相关，与 SAPS II 无关（调整后 OR 3.29[95%CI，2.08-5.19]，p<0.0001）。在有膝部皮肤斑点的患者中，斑点的持续存在与 ICU 死亡率增加独立相关，而与斑点出现时的器官功能障碍无关（OR 2.77[95%CI，1.34-5.72]，p=0.004）。
皮肤斑点在入住 ICU 的患者中很常见。皮肤斑点的发生和持续存在与 ICU 死亡率独立相关。
