Skip to Main content Skip to Navigation
Journal articles

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

Abstract : AbstractBackgroundMottling 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.MethodsThis 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.ResultsWe 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.ConclusionMottling 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.
Document type :
Journal articles
Complete list of metadatas

Cited literature [32 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-01546619
Contributor : Bmc Bmc <>
Submitted on : Sunday, June 25, 2017 - 5:21:21 AM
Last modification on : Wednesday, August 19, 2020 - 11:58:40 AM
Long-term archiving on: : Wednesday, January 17, 2018 - 3:46:55 PM

Files

13054_2017_Article_1742.pdf
Publication funded by an institution

Identifiers

Citation

Simon Bourcier, Jérémie Joffre, Vincent Dubée, Gabriel Preda, Jean-Luc Baudel, et al.. Marked regional endothelial dysfunction in mottled skin area in patients with severe infections. Critical Care, BioMed Central, 2016, 21 (1), pp.155. ⟨10.1186/s13054-017-1742-x⟩. ⟨inserm-01546619⟩

Share

Metrics

Record views

2300

Files downloads

1051