Corneal reflex: novel strong prognostic marker for imminent death

Abstract

Objectives This study aimed to evaluate the prognostic significance of the corneal reflex in predicting death within 24 hours among terminally ill patients with cancer. Methods This prospective observational study was conducted with patients with advanced cancer admitted to the hospice centre of Gyeongsang National University Hospital who were in the phase of impending death. Corneal reflex and other end-of-life signs were assessed three times daily by trained nurses using standardised criteria. Mixed-effects logistic regression was used to identify predictors of death within 24 hours, and diagnostic performance was examined for 24–96hours. Results A total of 665 observations was analysed. Absence of corneal reflex was strongly associated with death within 24 hours (OR 5.48, p<0.001), with a 24-hour mortality rate of 70.7%. It showed high specificity (85.0%) and positive predictive value (70.7%). Even among patients with a Richmond Agitation-Sedation Scale score of −4 or −5, absence of the corneal reflex remained a significant predictor of 24-hour mortality (71.2% vs 37.1%, p<0.001). Other significant predictors included peripheral cyanosis, oxygen desaturation and low blood pressure. Conclusions Absence of corneal reflex is a specific and clinically useful sign of imminent death within 24 hours in terminally ill patients with cancer, supporting its application in end-of-life prognostication and decision-making.