Incidence and risk factors of acute skin failure in patients with sepsis: a systematic review and meta-analysis
- 1Department of Nursing, Beijing TianTan Hospital, Capital Medical University
- 2Department of Intensive Care Unit, Beijing TianTan Hospital, Capital Medical University
Abstract
Purpose: This systematic review and meta-analysis aimed to determine the incidence and risk factors of acute skin failure (ASF) in patients with sepsis.
Methods: Two reviewers independently searched PubMed, Web of Science, Cochrane Database, Embase, CNKI, Wanfang Database, and VIP Database from database inception to December 2025. Observational studies reporting ASF incidence and risk factors in sepsis patients were included. Random-effects meta-analysis was used to pool incidence and odds ratios (ORs); case–control studies were excluded from incidence pooling and analyzed only for associated factors. Publication bias was assessed using funnel plots, Begg’s and Egger’s tests. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS) and the AHRQ checklist.
Results: Eighteen observational studies comprising 3,295 adult participants were included. After exclusion of two case–control studies from incidence pooling, the pooled ASF incidence across the 16 cohort and cross-sectional studies ( n = 2,697) was 45.2% (95% CI: 34.5–56.2%), with a 95% prediction interval of 12.2–83.0% and substantial heterogeneity ( I ² = 96.1%, p < 0.0001). Elevated arterial blood lactate [OR 1.20, 95% CI 1.15–1.25; p < 0.00001; I ² = 50%], higher SOFA score [OR 1.23, 95% CI 1.16–1.31; p < 0.00001; I ² = 20%], and higher APACHE II score [OR 1.16, 95% CI 1.10–1.21; p < 0.00001; I ² = 34%] were significantly associated with increased ASF risk, whereas lower mean arterial pressure was associated with ASF [OR 0.94, 95% CI 0.93–0.96; p < 0.00001; I ² = 47%]. Leave-one-out sensitivity analyses confirmed the robustness of the pooled estimates, and no significant publication bias was detected (Egger’s p = 0.467; Begg’s p = 0.239).
Conclusion: ASF affects a substantial proportion of patients with sepsis. Lactate, SOFA score, APACHE II score and MAP are variables associated with ASF that may support early identification of patients at heightened risk; prospective studies are needed to validate predictive models.
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BibTeX
@article{wang2026incidence,
title = {{Incidence and risk factors of acute skin failure in patients with sepsis: a systematic review and meta-analysis}},
author = {Wenshuang Wang and Tian Lang and Kai Zhao and Hong Zhang and Huan Shi and Yuan Yuan and Wei Cao},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1955939},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955939/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Incidence and risk factors of acute skin failure in patients with sepsis: a systematic review and meta-analysis
AU - Wenshuang Wang
AU - Tian Lang
AU - Kai Zhao
AU - Hong Zhang
AU - Huan Shi
AU - Yuan Yuan
AU - Wei Cao
PY - 2026
DA - 2026/10/14
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1955939
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955939/full
AB - Purpose: This systematic review and meta-analysis aimed to determine the incidence and risk factors of acute skin failure (ASF) in patients with sepsis. Methods: Two reviewers independently searched PubMed, Web of Science, Cochrane Database, Embase, CNKI, Wanfang Database, and VIP Database from database inception to December 2025. Observational studies reporting ASF incidence and risk factors in sepsis patients were included. Random-effects meta-analysis was used to pool incidence and odds ratios (ORs); case–control studies were excluded from incidence pooling and analyzed only for associated factors. Publication bias was assessed using funnel plots, Begg’s and Egger’s tests. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS) and the AHRQ checklist. Results: Eighteen observational studies comprising 3,295 adult participants were included. After exclusion of two case–control studies from incidence pooling, the pooled ASF incidence across the 16 cohort and cross-sectional studies ( n = 2,697) was 45.2% (95% CI: 34.5–56.2%), with a 95% prediction interval of 12.2–83.0% and substantial heterogeneity ( I ² = 96.1%, p < 0.0001). Elevated arterial blood lactate [OR 1.20, 95% CI 1.15–1.25; p < 0.00001; I ² = 50%], higher SOFA score [OR 1.23, 95% CI 1.16–1.31; p < 0.00001; I ² = 20%], and higher APACHE II score [OR 1.16, 95% CI 1.10–1.21; p < 0.00001; I ² = 34%] were significantly associated with increased ASF risk, whereas lower mean arterial pressure was associated with ASF [OR 0.94, 95% CI 0.93–0.96; p < 0.00001; I ² = 47%]. Leave-one-out sensitivity analyses confirmed the robustness of the pooled estimates, and no significant publication bias was detected (Egger’s p = 0.467; Begg’s p = 0.239). Conclusion: ASF affects a substantial proportion of patients with sepsis. Lactate, SOFA score, APACHE II score and MAP are variables associated with ASF that may support early identification of patients at heightened risk; prospective studies are needed to validate predictive models.
SN - 2296-2565
ER -