Objective: To explore predictive effect of skin mettling score combined with lactic acid for acute skin failure(ASF) in septic shock patients. Methods: A total of 123 patients with septic shock admitted to the emergency care unit from July 2020 to December 2021 were collected by convenience sampling method. The patients were divided into ASF group(n=30) and non-ASF group(n=93), and the data of the two groups were compared. The predictive value of each factor and skin mettling score combined with lactic acid was analyzed by area under ROC curve. Results: The area under ROC curve of skin mettling score combined with lactic acid was 0. 931, the sensitivity was 0. 867, the specificity was 0. 957, the Youden index was 0. 824. Conclusions: Skin mettling score combined with lactic acid can effectively predict the occurrence of ASF in patients with septic shock. The constructed prediction model could provide reference for medical staff toearly monitor and intervene acute skin failure in patients with sepsis in emergency department.