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Abstract

Title Facial expression with the type of eye opening associates with multi-organ failure: an Observational prospective ICU cohort study Background Accurate prognostication in the intensive care unit (ICU) remains a challenging task. Conventional severity scores such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) quantify physiological derangement but overlook real-time neurological and affective responsiveness. Behavioral indicators—particularly facial expressivity and eye-opening response—may reflect cortical and brainstem integrity, offering a simple, non-invasive adjunct for bedside mortality prediction. Methods In this single-center, prospective observational study, 210 adult patients in the ICU were assessed within 24 hours of admission. Two blinded observers evaluated facial expression (happy, sad, angry, confused, or surprised) and eye-opening response (spontaneous, to speech, to pain, or none) during light sedation or sedation-free intervals. Physiological severity was measured using the APACHE II score. Logistic regression identified independent predictors of 90-day mortality, and receiver operating characteristic (ROC) analysis evaluated discriminative performance. Results Among 210 participants (mean age = 64 years; 51% male), nearly half died within 90 days. Non-survivors exhibited higher APACHE II scores, longer ICU stays, and greater ventilation requirements (p < 0.001 for all). Both abnormal facial expression and impaired eye-opening were significantly associated with mortality (p < 0.001). In multivariable analysis, abnormal facial expression, impaired eye-opening, and higher APACHE II scores independently predicted death (p < 0.01). ROC analysis showed fair-to-good discrimination (AUC ≈ 0.79 for facial expression; 0.69 for eye-opening). Conclusion Facial expressivity and eye-opening responsiveness are independent behavioral predictors of short-term mortality in critically ill patients. Integrating these markers with physiological indices may enhance early risk stratification and guide individualized ICU decision-making. Multicenter validation with standardized sedation protocols is recommended.

Article Type

Original Study

Subject Area

Critical Care Medicine

IRB Number

Hsh00090

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

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