Corneal reflex: novel strong prognostic marker for imminent death

Area of Science:

• Palliative Care Medicine
• Oncology
• Clinical Prognostication

Background:

• Accurate prognostication is crucial for end-of-life care in terminally ill cancer patients.
• Identifying reliable clinical signs of imminent death aids in decision-making and patient comfort.

Purpose of the Study:

• To evaluate the prognostic significance of the corneal reflex in predicting 24-hour mortality in advanced cancer patients.
• To assess the diagnostic performance of the corneal reflex for end-of-life prognostication.

Main Methods:

• Prospective observational study of terminally ill cancer patients in a hospice setting.
• Corneal reflex and other end-of-life signs assessed thrice daily by trained nurses.
• Mixed-effects logistic regression analysis to identify predictors of 24-hour mortality.

Main Results:

• Absence of corneal reflex strongly predicted death within 24 hours (OR 5.48, p<0.001), with 70.7% 24-hour mortality.
• High specificity (85.0%) and positive predictive value (70.7%) for the corneal reflex.
• Absence of corneal reflex remained significant even in sedated patients (RASS -4/-5), predicting 71.2% mortality.

Conclusions:

• Absence of the corneal reflex is a specific and clinically useful sign of imminent death within 24 hours.
• This sign supports its application in end-of-life prognostication for cancer patients.
• Findings aid in clinical decision-making for terminally ill patients.