Abstract：
BACKGROUND: Assessing pupil size and reactivity is the standard of care in neurocritically ill patients. Anisocoria observed in critically ill patients often prompts further investigation and treatment. This study explores anisocoria at rest and after light stimulus determined using quantitative pupillometry as a predictor of discharge modified Rankin Scale (mRS) scores.
METHODS: This analysis includes data from an international registry and includes patients with paired (left and right eye) quantitative pupillometry readings linked to discharge mRS scores. Anisocoria was defined as the absolute difference in pupil size using three common cut points (> 0.5 mm, > 1 mm, and > 2 mm). Nonparametric models were constructed to explore patient outcome using three predictors: the presence of anisocoria at rest (in ambient light); the presence of anisocoria after light stimulus; and persistent anisocoria (present both at rest and after light). The primary outcome was discharge mRS score associated with the presence of anisocoria at rest versus after light stimulus using the three commonly defined cut points.
RESULTS: This analysis included 152,905 paired observations from 6,654 patients with a mean age of 57.0 (standard deviation 17.9) years, and a median hospital stay of 5 (interquartile range 3-12) days. The mean admission Glasgow Coma Scale score was 12.7 (standard deviation 3.5), and the median discharge mRS score was 2 (interquartile range 0-4). The ranges for absolute differences in pupil diameters were 0-5.76 mm at rest and 0-6.84 mm after light. Using an anisocoria cut point of > 0.5 mm, patients with anisocoria after light had worse median mRS scores (2 [interquartile range 0-4]) than patients with anisocoria at rest (1 [interquartile range 0-3]; P < .0001). Patients with persistent anisocoria had worse median mRS scores (3 [interquartile range 1-4]) than those without persistent anisocoria (1 [interquartile range 0-3]; P < .0001). Similar findings were observed using a cut point for anisocoria of > 1 mm and > 2 mm.
CONCLUSIONS: Anisocoria after light is a new biomarker that portends worse outcome than anisocoria at rest. After further validation, anisocoria after light should be considered for inclusion as a reported and trended assessment value.
METHODS: This analysis includes data from an international registry and includes patients with paired (left and right eye) quantitative pupillometry readings linked to discharge mRS scores. Anisocoria was defined as the absolute difference in pupil size using three common cut points (> 0.5 mm, > 1 mm, and > 2 mm). Nonparametric models were constructed to explore patient outcome using three predictors: the presence of anisocoria at rest (in ambient light); the presence of anisocoria after light stimulus; and persistent anisocoria (present both at rest and after light). The primary outcome was discharge mRS score associated with the presence of anisocoria at rest versus after light stimulus using the three commonly defined cut points.
RESULTS: This analysis included 152,905 paired observations from 6,654 patients with a mean age of 57.0 (standard deviation 17.9) years, and a median hospital stay of 5 (interquartile range 3-12) days. The mean admission Glasgow Coma Scale score was 12.7 (standard deviation 3.5), and the median discharge mRS score was 2 (interquartile range 0-4). The ranges for absolute differences in pupil diameters were 0-5.76 mm at rest and 0-6.84 mm after light. Using an anisocoria cut point of > 0.5 mm, patients with anisocoria after light had worse median mRS scores (2 [interquartile range 0-4]) than patients with anisocoria at rest (1 [interquartile range 0-3]; P < .0001). Patients with persistent anisocoria had worse median mRS scores (3 [interquartile range 1-4]) than those without persistent anisocoria (1 [interquartile range 0-3]; P < .0001). Similar findings were observed using a cut point for anisocoria of > 1 mm and > 2 mm.
CONCLUSIONS: Anisocoria after light is a new biomarker that portends worse outcome than anisocoria at rest. After further validation, anisocoria after light should be considered for inclusion as a reported and trended assessment value.
摘要：
背景：评估瞳孔大小和反应性是神经危重患者的护理标准。在危重患者中观察到的焦虑通常会提示进一步的调查和治疗。这项研究探讨了使用定量瞳孔测量法确定的静息和光刺激后的不等症状，以预测放电改良的Rankin量表（mRS）评分。
方法：该分析包括来自国际注册中心的数据，并包括具有与出院mRS评分相关的配对（左眼和右眼）定量瞳孔测量读数的患者。使用三个常见切割点（>0.5mm，>1mm,和>2毫米）。使用三个预测因子构建非参数模型来探索患者的预后：静息时（在环境光下）存在不等眼；光刺激后存在不等眼；和持续性不等眼（在静息和光照后都存在）。主要结果是使用三个通常定义的切点，与静息时与光刺激后的不等不适相关的出院mRS评分。
结果：该分析包括来自6,654名平均年龄为57.0（标准偏差17.9）岁的患者的152,905配对观察结果，中位住院时间为5天（四分位距3-12天）。平均入院格拉斯哥昏迷量表评分为12.7（标准差3.5），出院mRS评分中位数为2分（四分位距0-4分）。瞳孔直径的绝对差异范围在休息时为0-5.76mm，光照后为0-6.84mm。使用>0.5毫米的失足切断点，与静息状态下(1[四分位数范围0-3];P<0.0001)相比,光照后出现不等眼的患者mRS评分中位数(2[四分位数范围0-4];P<0.0001)较差.患有持续性不等的患者的mRS评分中位数（3[四分位距1-4]）比没有持续性不等的患者（1[四分位距0-3]；P<0.0001）更差。使用>1mm和>2mm的不等眼的切点观察到类似的发现。
结论：光照后焦虑是一种新的生物标志物，预示着比休息时焦虑更差的结果。经过进一步验证，光照后的不适应考虑纳入报告和趋势评估值。
方法：该分析包括来自国际注册中心的数据，并包括具有与出院mRS评分相关的配对（左眼和右眼）定量瞳孔测量读数的患者。使用三个常见切割点（>0.5mm，>1mm,和>2毫米）。使用三个预测因子构建非参数模型来探索患者的预后：静息时（在环境光下）存在不等眼；光刺激后存在不等眼；和持续性不等眼（在静息和光照后都存在）。主要结果是使用三个通常定义的切点，与静息时与光刺激后的不等不适相关的出院mRS评分。
结果：该分析包括来自6,654名平均年龄为57.0（标准偏差17.9）岁的患者的152,905配对观察结果，中位住院时间为5天（四分位距3-12天）。平均入院格拉斯哥昏迷量表评分为12.7（标准差3.5），出院mRS评分中位数为2分（四分位距0-4分）。瞳孔直径的绝对差异范围在休息时为0-5.76mm，光照后为0-6.84mm。使用>0.5毫米的失足切断点，与静息状态下(1[四分位数范围0-3];P<0.0001)相比,光照后出现不等眼的患者mRS评分中位数(2[四分位数范围0-4];P<0.0001)较差.患有持续性不等的患者的mRS评分中位数（3[四分位距1-4]）比没有持续性不等的患者（1[四分位距0-3]；P<0.0001）更差。使用>1mm和>2mm的不等眼的切点观察到类似的发现。
结论：光照后焦虑是一种新的生物标志物，预示着比休息时焦虑更差的结果。经过进一步验证，光照后的不适应考虑纳入报告和趋势评估值。
