Incidence and risk factors of acute skin failure in patients with sepsis: a systematic review and meta-analysis

PurposeThis systematic review and meta-analysis aimed to determine the incidence and risk factors of acute skin failure (ASF) in patients with sepsis.MethodsTwo 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.ResultsEighteen 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 (I2 = 96.1%, p < 0.0001). Elevated arterial blood lactate [OR 1.20, 95% CI 1.15–1.25; p < 0.00001; I2 = 50%], higher SOFA score [OR 1.23, 95% CI 1.16–1.31; p < 0.00001; I2 = 20%], and higher APACHE II score [OR 1.16, 95% CI 1.10–1.21; p < 0.00001; I2 = 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; I2 = 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).ConclusionASF 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.