Skin perfusion parameters Mottling Score, CRT, and PPI correlate with higher mortality in sepsis patientsSkin Perfusion Markers Linked to Higher Sepsis Mortality Risk

Shock (Augusta, Ga.) Published August 3, 2026 Study authors: Shi Li Juan, Ke Shu Fen, Fu Li Sang, Zhu Li Mei, Chen Liang Ying, Zhuang Yao Ning PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that MS, CRT, and PPI are associated with increased mortality risk in patients with sepsis and septic shock.

This meta-analysis synthesized data from 22 articles involving 2,727 subjects to evaluate the association between skin perfusion parameters and mortality in patients with sepsis and septic shock. The analysis focused on three specific markers: mottling score (MS), capillary refill time (CRT), and peripheral perfusion index (PPI).

The findings indicate that higher mottling scores are associated with increased 14-day mortality (OR = 1.96, 95% CI: 1.32-2.91) and 28-day mortality (OR = 2.27, 95% CI: 1.79-2.87). Prolonged capillary refill time is associated with increased in-hospital mortality (OR = 2.46, 95% CI: 1.18-5.12) and 28-day mortality (OR = 3.29, 95% CI: 2.08-5.21). Additionally, a reduced peripheral perfusion index is associated with increased in-hospital mortality (OR = 4.56, 95% CI: 3.32-6.21) and 28-day mortality (OR = 5.05, 95% CI: 3.65-6.98).

The authors note that the study is limited by a need for larger prospective studies to standardize assessment protocols and intervention thresholds. While these parameters may assist in early clinical identification and risk stratification, the associations are based on cohort and case-control studies and do not establish causality.

How this fits prior evidence

This meta-analysis addresses a gap in identifying early risk factors for sepsis patients. It complements prior evidence regarding sepsis incidence linked to age, male sex, low BMI, and comorbidities like diabetes. While previous findings established these demographic risks, this study provides specific clinical markers (MS, CRT, and PPI) that correlate with mortality outcomes in those already diagnosed with sepsis.

Researchers analyzed data from 2,727 patients with sepsis and septic shock to see if skin perfusion markers could predict survival. They looked at three specific indicators: the Mottling Score (MS), capillary refill time (CRT), and peripheral perfusion index (PPI). These measures look at how blood flows through the skin.

The study found that all three signs were linked to a higher risk of death. For example, patients with a high Mottling Score had a significantly higher risk of dying within 14 or 28 days. Similarly, a slow capillary refill time and a low peripheral perfusion index were associated with increased mortality rates during hospital stays.

Because these results come from an analysis of existing observational studies, they show a link rather than a direct cause. The study is also limited by the fact that more large-scale trials are needed to standardize how these tests are performed. These findings may help doctors identify high-risk patients sooner, but they should be used as one part of a complete clinical picture.

What this means for you:

Skin perfusion markers like mottling and refill time are linked to higher mortality risk in sepsis patients.

Common questions

What skin markers were linked to sepsis risk?

The study identified three main indicators: Mottling Score (MS), capillary refill time (CRT), and peripheral perfusion index (PPI). All three were associated with a higher risk of mortality in patients suffering from sepsis or septic shock.

How much did these markers affect the risk of death?

The data showed significant links. For example, a low peripheral perfusion index was linked to an odds ratio of 5.05 for 28-day mortality. A prolonged capillary refill time was associated with an odds ratio of 3.29 for 28-day mortality.

Can these tests be used to treat patients?

These markers are currently used to help doctors identify and categorize the risk level of a patient's condition. Because this was an observational analysis, it shows a correlation rather than a direct cause for treatment.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedAug 2026

PMID42258324

View Original Abstract ↓

BACKGROUND: Despite advances in intensive care, sepsis and septic shock still have high morbidity and mortality. Microcirculatory disturbance is a key issue in sepsis, leading to hypoperfusion, hypoxia, and organ failure. The skin is a sensitive indicator of microcirculatory changes and often shows early systemic changes. Recently, bedside skin perfusion indicators such as the mottling score (MS), capillary refill time (CRT), and peripheral perfusion index (PPI) have become common in practice. However, their value in predicting outcomes lacks strong evidence. METHODS: A systematic search was conducted across databases, including PubMed, Web of Science, Cochrane Library, EBSCO, China National Knowledge Infrastructure, Wanfang, and VIP, with a search period spanning from the inception of the databases to January 2026. Cohort studies or case-control studies investigating the correlation between skin perfusion parameters and the prognosis of sepsis patients (primary outcomes: 28-day mortality, 14-day mortality, and in-hospital mortality) were included. Two researchers independently performed literature screening, data extraction, and assessment of the Newcastle-Ottawa Scale (NOS) bias risk. A meta-analysis was performed using RevMan 5.4.1 software. RESULTS: This study included a total of 22 articles, encompassing 2,727 study subjects. The meta-analysis results demonstrated that: 1) MS was significantly associated with 28-day mortality [odds ratio (OR) = 2.27, 95% confidence interval (CI): 1.79-2.87, P < 0.001] and 14-day mortality (OR = 1.96, 95% CI: 1.32-2.91, P < 0.001); 2) prolonged CRT duration was significantly associated with 28-day mortality (OR = 3.29, 95% CI: 2.08-5.21, P < 0.001) and in-hospital mortality (OR = 2.46, 95% CI: 1.18-5.12, P < 0.001); 3) reduced PPI was significantly associated with 28-day mortality (OR = 5.05, 95% CI: 3.65-6.98, P < 0.001) and in-hospital mortality (OR = 4.56, 95% CI: 3.32-6.26, P < 0.001). Sensitivity analysis confirmed robust results with no significant publication bias. CONCLUSION: The MS, CRT, and PPI, as bedside and noninvasive skin perfusion parameters, demonstrate significant predictive value for mortality risk in sepsis patients. Integrating these indicators facilitates early clinical identification of high-risk patients, guiding risk stratification, and resuscitation therapy. Future large-sample prospective studies are required to further standardize their assessment protocols and intervention thresholds.

Skin perfusion parameters Mottling Score, CRT, and PPI correlate with higher mortality in sepsis patientsSkin Perfusion Markers Linked to Higher Sepsis Mortality Risk

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Common questions

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Skin perfusion parameters Mottling Score, CRT, and PPI correlate with higher mortality in sepsis patientsSkin Perfusion Markers Linked to Higher Sepsis Mortality Risk

How this fits prior evidence

Common questions

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Study Details

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