Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Apr 2;28(1):106.
doi: 10.1186/s13054-024-04891-6.

Facial appearance associates with longitudinal multi-organ failure: an ICU cohort study

Eline G M Cox  1 , Bas C T van Bussel  2   3 , Nerea Campillo Llamazares  4 , Jan-Willem E M Sels  2   3 , Marisa Onrust  4 , Iwan C C van der Horst  2   3 , Jacqueline Koeze  4 ; SICS Study Group
Collaborators, Affiliations
Observational Study

Facial appearance associates with longitudinal multi-organ failure: an ICU cohort study

Eline G M Cox et al. Crit Care. .

Abstract

Background: Facial appearance, whether consciously or subconsciously assessed, may affect clinical assessment and treatment strategies in the Intensive Care Unit (ICU). Nevertheless, the association between objective clinical measurement of facial appearance and multi-organ failure is currently unknown. The objective of this study was to examine whether facial appearance at admission is associated with longitudinal evaluation of multi-organ failure.

Methods: This was a sub-study of the Simple Intensive Care Studies-II, a prospective observational cohort study. All adult patients acutely admitted to the ICU between March 26, 2019, and July 10, 2019, were included. Facial appearance was assessed within three hours of ICU admission using predefined pictograms. The SOFA score was serially measured each day for the first seven days after ICU admission. The association between the extent of eye-opening and facial skin colour with longitudinal Sequential Organ Failure Assessment (SOFA) scores was investigated using generalized estimation equations.

Results: SOFA scores were measured in 228 patients. Facial appearance scored by the extent of eye-opening was associated with a higher SOFA score at admission and follow-up (unadjusted 0.7 points per step (95%CI 0.5 to 0.9)). There was no association between facial skin colour and a worse SOFA score over time. However, patients with half-open or closed eyes along with flushed skin had a lower SOFA score than patients with a pale or normal facial skin colour (P-interaction < 0.1).

Conclusions: The scoring of patients' facial cues, primarily the extent of eye-opening and facial colour, provided valuable insights into the disease state and progression of the disease of critically ill patients. The utilization of advanced monitoring techniques that incorporate facial appearance holds promise for enhancing future intensive care support.

Keywords: Critical care; Facial appearance; Facial monitoring; Gut feeling; Multi-organ failure.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The predefined pictograms. A Distribution of the different pictograms. B. Longitudinal trajectories of SOFA scores over time according to eye-opening*. †died in-hospital; SOFA: Sequential Organ Failure Assessment;  *Data was collected until day seven of ICU admission because most deteriorations are expected to occur within that timeframe, and 84% of patients were discharged within seven days. Therefore, the SOFA scores on days 6 and 7 were grouped. SOFA scores were calculated only for the days the patient was admitted to the ICU
See this image and copyright information in PMC

References

    1. Forte C, Voinea A, Chichirau M, Yeshmagambetova G, Albrecht LM, Erfurt C, et al. Deep learning for identification of acute illness and facial cues of illness. Front Med. 2021. 10.3389/fmed.2021.661309. - PMC - PubMed
    1. Axelsson J, Sundelin T, Olsson MJ, Sorjonen K, Axelsson C, Lasselin J, et al. Identification of acutely sick people and facial cues of sickness. Proc R Soc B Biol Sci. 2018;285:3–9. - PMC - PubMed
    1. Shiber J, Fontane E, Patel J, Akinleye A, Kerwin A, Chiu W, et al. Gestalt clinical severity score (GCSS) as a predictor of patient severity of illness or injury. Am J Emerg Med. 2023;66:11–15. doi: 10.1016/j.ajem.2023.01.005. - DOI - PubMed
    1. Madrigal-Garcia MI, Rodrigues M, Shenfield A, Singer M, Moreno-Cuesta J. What faces reveal: a novel method to identify patients at risk of deterioration using facial expressions. Crit Care Med. 2018;46:1057–1062. doi: 10.1097/CCM.0000000000003128. - DOI - PubMed
    1. Wiersema R, Castela Forte JN, Kaufmann T, de Haas RJ, Koster G, Hummel YM, et al. Observational study protocol for repeated clinical examination and critical care ultrasonography within the simple intensive care studies. J Vis Exp. 2019. 10.3791/58802-v. - PubMed

Publication types

LinkOut - more resources