title: Exploration of skin perfusion in cirrhotic patients with septic shock.
abstract: OBJECTIVE
  Skin perfusion alterations are early and strong predictors of death in patients with septic shock. Cirrhosis is associated with systemic vasodilation and increases mortality from septic shock. We aimed at assessing whether the mottling score and tissue oxygen saturation (StO2) could be used as early predictors of death in cirrhotic patients with septic shock.
  
  
  METHODS
  This observational study included cirrhotic patients with septic shock. Each 6 h during the first 24 h, we collected data reflecting macrocirculation (mean arterial pressure, heart rate, central venous pressure, and cardiac output) and organ perfusion (arterial lactate, urinary output, ScvO2, mottling score, thenar, and knee StO2). Data of 75 non-cirrhotic patients with previously reported septic shock were used as control.
  
  
  RESULTS
  42 cirrhotic patients were included. Mortality at day 14 was 71%. At H6, parameters reflecting macrocirculation were not associated with mortality, whereas higher arterial lactate and mottling score were associated with death. Mottling score was the strongest predictor of mortality (sensitivity=0.63, specificity=1, OR=42.4 (2.3-785.9)). At H6, knee StO2 decreased in non-survivors and predicted death (sensitivity=0.45, specificity=1). In comparison with control, mottling kinetic was different in cirrhotic patients (delayed mottling appearance in non-survivors, earlier mottling disappearance in survivors). Knee StO2 and skin perfusion, assessed by laser-Doppler, were higher in cirrhotic patients.
  
  
  CONCLUSIONS
  Mottling score and knee StO2 at H6 were very specific predictors of death in patients with cirrhosis and septic shock. Their sensitivity was lower in cirrhotic patients due to delayed mottling appearance and higher knee StO2 related to higher skin perfusion.
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; INSERM, UMR_S 938, CdR Saint-Antoine, F-75012 Paris, France. Electronic address: galbois@gmail.com.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Galbois
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France.
authors.forename: Naïke
authors.initials: N
authors.lastname: Bigé
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Pichereau
authors.affiliation: Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; AP-HP, Hôpital Saint-Antoine, Service de Santé Publique, F-75012 Paris, France; INSERM, UMR_S 707, F-75012 Paris, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boëlle
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Baudel
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Bourcier
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; INSERM, UMR_S 707, F-75012 Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; INSERM, UMR_S 707, F-75012 Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, F-75012 Paris, France; Université Pierre et Marie Curie (UPMC), Univ Paris 06, Sorbonne Universités, F-75005 Paris, France; Paris Research Cardiovascular Center, Inserm U970, Paris, France.
authors.forename: Hafid
authors.initials: H
authors.lastname: Ait-Oufella
mesh_terms: D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D007717:Knee; D017078:Laser-Doppler Flowmetry; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D012867:Skin / Q000098:blood supply* / Q000000981:diagnostic imaging; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D010100:Oxygen
keywords: Cirrhosis; Haemodynamic; ICU; Outcome; Septic shock