RESULTS: We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24 h after admission and prior to discharge. The results were compared with those of a group of 100 healthy volunteers who also underwent pupillometry. The maximum baseline pupil size (MBPS) and the minimum pupil diameter (MPD) were measured. Patients with decompensated HF have a higher MBPS (3.64 ± 0.81) and higher MPD (2.60 ± 0.58) than HF patients at discharge and in the control group (P-value = 0.01 and 0.01, respectively). Also, HF patients presented an improvement in pupillometric values at discharge [MBPS (3.47 ± 0.79) and MPD (2.51 ± 0.58)] and showed no differences compared with the control group [MBPS (3.34 ± 0.82) and MPD (2.40 ± 0.53)] (P-value = 0.19 and 0.14, respectively). In addition, MBPS provides a good independent predictor of in-hospital and 1 month mortality in patients admitted with HF. Six patients (5.61%) died during hospital admission, and 11 patients (10.2%) died in the first month after discharge. Also, four patients (3.74%) were readmitted within 1 month of discharge. The receiver operating characteristic (ROC) curve for predicting in-hospital mortality through MBPS was 0.823. No patient with an MBPS < 3.7 mm died. The ROC curve for predicting combined mortality or readmission within the first month for MBPS was 0.698.
CONCLUSIONS: Pupillometry may be a new, non-invasive, and simple tool to determine the status of SNS, help in the prognostic stratification of acute HF patients, and improve therapeutic management.
结果:我们前瞻性和连续纳入了107例失代偿性HF患者。在入院后和出院前的第一个24小时内,使用NeuroOpics进行定量瞳孔测量。将结果与一组100名也进行了瞳孔测量的健康志愿者的结果进行了比较。测量最大基线瞳孔大小(MBPS)和最小瞳孔直径(MPD)。失代偿性HF患者出院时的MBPS(3.64±0.81)和MPD(2.60±0.58)高于HF患者和对照组(P值分别为0.01和0.01)。此外,HF患者出院时的瞳孔测量值[MBPS(3.47±0.79)和MPD(2.51±0.58)]有所改善,与对照组[MBPS(3.34±0.82)和MPD(2.40±0.53)]相比无差异(P值分别为0.19和0.14)。此外,MBPS为HF患者住院和1个月死亡率提供了良好的独立预测因子。6名患者(5.61%)在入院时死亡,出院后第一个月死亡11例(10.2%)。此外,4例患者(3.74%)在出院后1个月内再次入院.通过MBPS预测住院死亡率的受试者工作特征(ROC)曲线为0.823。MBPS<3.7mm的患者没有死亡。预测MBPS第一个月内合并死亡率或再入院的ROC曲线为0.698。
结论:瞳孔测量可能是一种新的,非侵入性,和简单的工具来确定SNS的状态,有助于急性HF患者的预后分层,改善治疗管理。