title: Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France, r.coudroy@yahoo.fr.
authors.forename: Rémi
authors.initials: R
authors.lastname: Coudroy
authors.forename: Angéline
authors.initials: A
authors.lastname: Jamet
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Frat
authors.forename: Anne
authors.initials: A
authors.lastname: Veinstein
authors.forename: Delphine
authors.initials: D
authors.lastname: Chatellier
authors.forename: Véronique
authors.initials: V
authors.lastname: Goudet
authors.forename: Severin
authors.initials: S
authors.lastname: Cabasson
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.forename: René
authors.initials: R
authors.lastname: Robert
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007717:Knee / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D012307:Risk Factors; D012772:Shock, Septic / Q000401:mortality* / Q000473:pathology*; D012867:Skin / Q000098:blood supply*