Mottling Incidence and Mottling Score According to Arterial Lactate Level in Septic Shock Patients

Objectives: Mottling score is estimated from 0-5 according to mottling over the knee and described as clinical evaluation of tissue perfusion. This score was developed with ancient definitions of sepsis without lactate level, a major prognostic parameter when superior to 2 mmol/L. This study describes mottling incidence and mottling score in septic shock patients according to lactate level. Materials and methods: We reanalyzed our prospective study in a French tertiary hospital in the intensive care unit (ICU) which studied mottling score and thermography correlation. Patients admitted to septic shock diagnosis and requiring vasoactive drugs were included. We recorded hemodynamic variables, mottling score, and lactate. Data collection was realized at ICU admission (H0) and after six hours (H6). Results: Forty-three patients were included. Mean age was 67 (+/- 4), mean sequential organ failure assessment (SOFA) score was 11 (8-12), and SAPS II 58 +/- 20. Mortality rate at day 28 was 30%. Among patients with lactate >= 2 mmol/L, mottling was more prevalent in 82.6% vs 47.4% (p value = 0.016), and at H6 mottling score was higher (p value = 0.009). Although, mottling incidence was not different between dead (85%) and survivors (81%; p value = 0.795). Conclusion: A new sepsis definition implies a new epidemiology in mottling according to lactate threshold. Patients with lactate >= 2 mmol/L presented a higher incidence and score of mottling. However, mortality was not influenced by mottling in this study. Clinical significance: Arterial lactate is a major prognostic parameter when superior to 2 mmol/L. A new definition of sepsis was published in 2016 with a new paradigm and epidemiology of septic shock Patients with lactate >= 2 mmol/L presented a higher incidence and score of mottling. Mottling score is a clinical sign of microcirculatory alteration, related to lactate level in septic shock.