https://doi.org/10.4081/ecj.2024.12569

Persistent cool extremities as an independent predictor of adverse clinical outcomes among critically ill patients: a single-center retrospective observational study

Early Access
Submitted: 15 April 2024
Accepted: 17 June 2024
Published: 23 July 2024
Physical examination, skin perfusion, shock, critically ill
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Authors

Masatoshi Uchida
m-uchida@dokkyomed.ac.jp
Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan.
Migaku Kikuchi
Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan.
Eisei Hoshiyama
Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
Koji Wake
Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan.

Cool extremities representing impaired skin perfusion are a classical sign of shock. We evaluated associations between the presence and persistence of subjective cool extremities observed by caring nurses and clinical outcomes. We conducted a retrospective observational study in an Intensive Care Unit (ICU) at a university hospital in Japan. Patients were divided into two groups based on the presence or absence of subjective cool extremities during the first 24 hours of their ICU stay. We compared their characteristics and outcomes. In total, 2956 patients were analyzed. Patients with cool extremities were older, had higher severity Acute Physiology and Chronic Health Evaluation (APACHE III) scores, had higher in-hospital mortality (4.1% vs 18%, p<0.001), and had a higher prevalence of acute kidney injury requiring renal replacement therapy (2.1% vs 10%, p<0.001) as compared to patients without nurse-reported cool extremities. Multivariable logistic regression showed cool extremities persisting for ≥12 hours were significantly associated with in-hospital death (adjusted Odds Ratio, OR, 1.64) and acute kidney injury requiring renal replacement therapy (adjusted OR 1.82). Patients with subjective cool extremities were more severely ill and had poorer outcomes. Subjective skin temperature assessment may be useful to detect high-risk patients.

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Sakr Y, Dubois M-J, De Backer D, et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 2004;32:1825-31.
Dubin A, Henriquez E, Hernández G. Monitoring peripheral perfusion and microcirculation. Curr Opin Crit Care 2018;24:173-80.
De Backer D, Ospina-Tascon G, Salgado D, et al. Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med 2010;36:1813-25.
Kaplan LJ, McPartland K, Santora TA, et al. Start with a subjective assessment of skin temperature to identify hypoperfusion in intensive care unit patients. J Trauma 2001;50:620-7.
Ait-Oufella H, Lemoinne S, Boelle PY, et al. Mottling score predicts survival in septic shock. Intensive Care Med 2011;37:801-7.
Lima A, Jansen TC, van Bommel J, et al. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med 2009;37:934-8.
Dumas G, Lavillegrand J-R, Joffre J, et al. Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters. Crit Care 2019;23:211.
Wiersema R, Koeze J, Eck RJ, et al. Clinical examination findings as predictors of acute kidney injury in critically ill patients. Acta Anaesthesiol Scand 2020;64:69-74.
Lin SJ-S, Cheng Y-Y, Chang C-H, et al. Traditional Chinese medicine diagnosis “yang-xu zheng”: significant prognostic predictor for patients with severe sepsis and septic shock. Evid Based Complement Alternat Med 2013;2013:759748.
Henning RJ, Wiener F, Valdes S, et al. Measurement of toe temperature for assessing the severity of acute circulatory failure. Surg Gynecol Obstet 1979;149:1-7.
Goldhill DR, McNarry AF, Hadjianastassiou VG, et al. The longer patients are in hospital before Intensive Care admission the higher their mortality. Intensive Care Med 2004;30:1908-13.
Onwochei DN, Fabes J, Walker D, et al. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia 2020;75:e62-74.
Harris S, Singer M, Sanderson C, et al. Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain. Intensive Care Med 2018;44:606-15.
Contou D, de Prost N. Skin mottling. N Engl J Med 2016;375:2187.
Kazune S, Caica A, Volceka K, et al. Relationship of mottling score, skin microcirculatory perfusion indices and biomarkers of endothelial dysfunction in patients with septic shock: an observational study. Crit Care 2019;23:311.
Coudroy R, Jamet A, Frat J-P, et al. Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients. Intensive Care Med 2015;41:452-9.
van Genderen ME, Paauwe J, de Jonge J, et al. Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults. Crit Care 2014;18:R114.
Ait-Oufella H, Bige N, Boelle PY, et al. Capillary refill time exploration during septic shock. Intensive Care Med 2014;40:958-64.
Hernandez G, Pedreros C, Veas E, et al. Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study. J Crit Care 2012;27:283-8.
Puskarich MA, Trzeciak S, Shapiro NI, et al. Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock. Chest 2013;143:1548-53.
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580-637.
Kushimoto S, Akaishi S, Sato T, et al. Lactate, a useful marker for disease mortality and severity but an unreliable marker of tissue hypoxia/hypoperfusion in critically ill patients. Acute Med Surg 2016;3:293-7.
Rodrigo V, Guillamet CV, Rishi MA, et al. Physical examination in the Intensive Care Unit: opinions of physicians at three teaching hospitals. Southwest J Pulm Crit Care 2015;10:34-43.

How to Cite

Uchida, M., Kikuchi, M., Hoshiyama, E., & Wake, K. (2024). Persistent cool extremities as an independent predictor of adverse clinical outcomes among critically ill patients: a single-center retrospective observational study. Emergency Care Journal. https://doi.org/10.4081/ecj.2024.12569
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