Prognostic value of pupil area for all-cause mortality in patients with heart failure

Aims: The area of the pupil can be used as an indicator of autonomic function. However, the relation between pupil area and prognosis in heart failure (HF) patients remains unclear. This study was performed to examine whether pupil area can be used as a prognostic indicator in patients with HF.

Methods and results: This retrospective review was performed in 870 consecutive patients (mean age: 67.0 ± 14.1 years, 37.0% women) hospitalized for acute HF. Pupil area was measured with a pupilometer at least 7 days after hospitalization for HF. The primary endpoint was all-cause mortality, and the secondary endpoint was readmission due to HF. A total of 131 patients died, and 328 patients were readmitted because of HF over a median follow-up of 1.9 (interquartile range: 1.0-3.7 years) years. After adjustment for several pre-existing prognostic factors, including Seattle Heart Failure Score (SHFS), pupil area was shown to be independently associated with all-cause mortality (hazard ratio: 0.72; 95% confidence interval: 0.59-0.88; P = 0.001) and readmission due to HF (hazard ratio: 0.82; 95% confidence interval: 0.73-0.93; P = 0.003). Addition of pupil area to SHFS significantly increased the area under the receiver-operating characteristic curve for all-cause mortality (0.69 vs. 0.72, respectively; P = 0.034).

Conclusions: Pupil area is an independent predictor of all-cause mortality and readmission due to HF and adds prognostic information to SHFS in patients with HF. The results presented here suggest that pupil area may be useful as a prognostic marker in patients with HF.