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Observational Report

doi: 10.1186/s13054-019-2589-0.

Relationship of mottling score, skin microcirculatory perfusion indices and biomarkers of endothelial dysfunction in patients with septic shock: an observational report

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• PMID: 31511042
• PMCID: PMC6739999
• DOI: 10.1186/s13054-019-2589-0

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Observational Report

Human relationship of mottling score, skin microcirculatory perfusion indices and biomarkers of endothelial dysfunction in patients with septic shock: an observational written report

Sigita Kazune  et al. Crit Care. 2019 .

Gratis PMC article

Abstruse

Groundwork: In patients with septic daze, the skin is often called for the evaluation of peripheral perfusion and oxygenation. Changes in skin microcirculatory vessel oxygen saturation and relative hemoglobin concentration can be described using a mottling score or captured with hyperspectral imaging. However, the effectiveness of the mottling score in assessing microcirculation remains to exist shown. Nosotros hypothesize that the mottling score in patients with septic stupor is related to skin microcirculatory perfusion indices quantified by hyperspectral imaging, biomarkers that reflect endothelium activation and impairment, and clinical outcome.

Methods: Hyperspectral imaging of the knee area was performed in 95 intensive intendance patients with septic shock enrolled in a unmarried-middle observational study to obtain relative oxy/deoxyhemoglobin concentration values and construct anatomical maps of peel microcirculatory saturation. The blood was sampled to obtain concentrations of thrombomodulin, plasminogen activator inhibitor-1 (PAI-1), soluble intercellular adhesion molecule-ane (ICAM-1), soluble vascular prison cell adhesion molecule-1 (VCAM-one), angiopoietin-2, and syndecan-1. The spectrophotometrically obtained pare microvascular perfusion indices were compared to the mottling score and biomarker concentration. The clan between mottling score, skin microcirculatory perfusion indices, and 28-day mortality was also analyzed.

Results: Microcirculatory oxygen saturation was significantly lower and full hemoglobin concentration was significantly college in patients with a mottling score of ii compared to those with a score of 0 (p = 0.02), with no departure between other scores. We found an association between microcirculatory oxygen saturation and PAI-1 levels (rho = - 0.3; p = 0.007). Increased mottling score and decreased microcirculatory oxygen saturation were predictive of 28-day bloodshed (mottling score 2 vs 0: OR 15.31, 95% CI 4.12-68.11; microcirculatory oxygen saturation: OR 0.90, 95% CI 0.85-0.95). Endothelial biomarkers did not increase the predictive value of skin microcirculatory perfusion indices.

Conclusions: Higher mottling scores are associated with lower microcirculatory oxygen saturation but with meaning overlap between scores. Microcirculatory oxygen saturation is a quantitative measure of peripheral oxygenation and is more specific than the mottling score in predicting 28-day mortality.

Keywords: Hyperspectral imaging; Microcirculation; Sepsis; Tissue oxygenation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Images of ii septic shock patients at unlike stages of processing. Segmented images were generated by dividing the hyperspectral cube into clusters with like spectral backdrop that correspond to the degree of blood pooling. Pare oxygen saturation maps were generated by calculating μHbSO₂ for each pixel in the region imaged. Each pixel was colored according to its value. Homogenous skin oxygenation is observed in a patient with higher μHbSO_two. In the case of low μHbSO₂, significant heterogeneity is present

Fig. two

Pare microcirculatory indices obtained from hyperspectral imaging co-ordinate to mottling score. a Peel microcirculatory oxygen saturation, expressed as percentage, and b skin total hemoglobin concentration, expressed in capricious units (a.u.), according to the mottling score. Information are presented every bit the means ± standard error

Fig. three

a–f Relationship between mottling score and biomarkers of endothelial activation. Data are presented as means ± standard fault

Fig. 4

a–f Relationship between pare microcirculatory saturation and biomarkers of endothelial activation. Information are presented as the means ± standard error

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