Comparison of Four Non-invasive Tools for Predicting Sepsis and Septic Shock Mortality: A Prospective Cohort Study

Guarino, Matteo; Maroncelli, Giacomo; Perna, Benedetta; Baldin, Paolo; Ghirardi, Caterina; Zanotto, Alex; Eichner, Silvia; Bolognesi, Matteo; Pesci, Chiara; Maritati, Martina; Contini, Carlo; De Giorgio, Roberto; Spampinato, Michele Domenico

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Clin Exp Emerg Med > Accepted Articles

Original Article

doi: https://doi.org/10.15441/ceem.25.075 [Accepted]

Comparison of Four Non-invasive Tools for Predicting Sepsis and Septic Shock Mortality: A Prospective Cohort Study

Matteo Guarino^1,2

, Giacomo Maroncelli¹, Benedetta Perna¹, Paolo Baldin¹, Caterina Ghirardi^1,2, Alex Zanotto¹, Silvia Eichner¹, Matteo Bolognesi¹, Chiara Pesci², Martina Maritati³, Carlo Contini³, Roberto De Giorgio¹

, Michele Domenico Spampinato^1,2

¹Department of Translational Medicine, University of Ferrara, Italy
²Emergency Department, S. Anna University Hospital of Ferrara, Italy
³Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy

Correspondence Roberto De Giorgio Email: dgrrrt@unife.it

Received: April 9, 2025. Revised: August 7, 2025. Accepted: August 9, 2025. Published online: December 2, 2025.

ABSTRACT

Objective
Sepsis, a life-threatening organ dysfunction, remains a major global health concern. Early detection remains challenging due to nonspecific symptoms. Non-invasive tools such as the Shock Index (SI), Diastolic Shock Index (DSI), Capillary Refill Time (CRT), and Mottling Score (MS) may help assess hemodynamic status and predict mortality, but a comprehensive comparison of their prognostic value is lacking. This study compares the performance of these tools in predicting mortality at 24 hours, 7 days, and 28 days in septic patients.
Methods
A monocentric, prospective observational study was conducted from January to September 2024. Adult patients (≥18 years) with suspected infection and a National Early Warning Score-2 ≥5 were enrolled. Demographic data, vital signs, CRT, MS, and mortality outcomes were recorded at 24 hours, 7 days, and 28 days.
Results
A total of 135 patients were included (median age 85 years, IQR 79–90; 44.4% female). Mortality rates were 15.6% at 24 hours, 25.2% at 7 days, and 35.6% at 28 days. CRT showed the highest predictive value for 24-hour mortality (AUC: 0.829, p<0.01), while MS had the best performance at 7 days (AUC: 0.732, p<0.01) and 28 days (AUC: 0.749, p<0.01). No significant differences emerged in pairwise comparisons.
Conclusion
While no tool was found to significantly outperform others, CRT and MS provide valuable, non-invasive mortality prediction in sepsis. Indeed, CRT is most effective for early risk stratification, while MS correlates with mid- and long-term outcomes, supporting their integration into clinical assessment.

Keywords: Capillary Refill Time, Diastolic shock index, Mottling Score, Sepsis, Septic Shock