Mottling as a prognosis marker in cardiogenic shock

Annals of Intensive Care

Research

Laurent Bonello¹  Bruno Levy²  Brahim Harbaoui³  Jean-Claude Dib⁴  Patrick Henry⁵  Etienne Puymirat⁶  Nicolas Combaret⁷  Guillaume Leurent⁸  Gerald Vanzetto⁹  Benoit Lattuca^1,10  Vincent Bataille^1,11  Anais Curtiaud^1,12  Ferhat Meziani^1,12  Hamid Merdji^1,12  Edouard Gerbaud^1,13  Hadi Khachab^1,14  Eric Bonnefoy^1,15  Caroline Biendel^1,16  Clément Delmas^1,17  Caroline Eva Gebhard^1,18  Francis Schneider^1,19  François Roubille^2,20  Marie-France Seronde^2,21  Severine Marchand^2,22  Pascal Lim^2,23  Benjamin Marchandot^2,24  Guillaume Schurtz^2,25 

[1] Aix-Marseille Université, 13385, Marseille, France;Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13385, Marseille, France;Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France;CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France;Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France;University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France;Clinique Ambroise Paré, Neuilly-sur-Seine, France;Department of Cardiology, AP-HP, Lariboisière University Hospital, Paris, France;Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015, Paris, France;Université de Paris, 75006, Paris, France;Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France;Department of Cardiology, CHU Rennes, Inserm, LTSI—UMR 1099, Univ Rennes 1, 35000, Rennes, France;Department of Cardiology, Hôpital de Grenoble, 38700, La Tronche, France;Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France;Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France;Faculté de Médecine, Strasbourg University Hospital, Nouvel Hôpital Civil, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg, France;Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604, Pessac, France;Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600, Pessac, France;Intensive Cardiac Care Unit, Department of Cardiology, CH d’Aix en Provence, Aix-en-Provence, France;Avenue des Tamaris, 13616, Aix-en-Provence cedex 1, France;Intensive Cardiac Care Unit, Lyon Bron University Hospital, Lyon, France;Intensive Cardiac Care Unit, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse Cedex, France;Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France;Intensive Cardiac Care Unit, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse Cedex, France;Recherche et Enseignement en Insuffisance Cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU Toulouse, Toulouse, France;Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland;Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France;PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Montpellier, France;Service de Cardiologie CHU Besançon, Besançon, France;Service de Cardiologie, Clinique Mutualiste, Grenoble, France;Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France;AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, 94010, Créteil, France;Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091, Strasbourg, France;Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000, Lille, France;

关键词: Cardiogenic shock;    Acute heart failure;    Perfusion;    Microcirculation;   

DOI  :  10.1186/s13613-023-01175-0

 received in 2023-04-20, accepted in 2023-08-22,  发布年份 2023

来源: Springer

【 摘 要 】

AimsImpact of skin mottling has been poorly studied in patients admitted for cardiogenic shock. This study aimed to address this issue and identify determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all etiologies.Methods and resultsFRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October, 2016. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 660 had skin mottling assessed at admission (85.5%) with almost 39% of patients in cardiogenic shock presenting mottling. The need for invasive respiratory support was significantly higher in patients with mottling (50.2% vs. 30.1%, p < 0.001) and likewise for the need for renal replacement therapy (19.9% vs. 12.4%, p = 0.09). However, the need for mechanical circulatory support was similar in both groups. Patients with mottling at admission presented a higher length of stay (19 vs. 16 days, p = 0.033), a higher 30-day mortality rate (31% vs. 23.3%, p = 0.031), and also showed significantly higher mortality at 1-year (54% vs. 42%, p = 0.003). The subgroup of patients in whom mottling appeared during the first 24 h after admission had the worst prognosis at 30 days.ConclusionSkin mottling at admission in patients with cardiogenic shock was statistically associated with prolonged length of stay and poor outcomes. As a perfusion-targeted resuscitation parameter, mottling is a simple, clinical-based approach and may thus help to improve and guide immediate goal-directed therapy to improve cardiogenic shock patients’ outcomes.Graphical Abstract

【 授权许可】

CC BY   
© La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF) 2023

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