Table 2. Interobserver agreement regarding the five signs.

	Kappa coefficient	Z value	P value
With natural-open eyes
Puffy eyelid	0.237	4.10	<0.001
Upper eyelid sulcus	0.529	9.17	<0.001
Wrinkles on the forehead	0.813	14.10	<0.001
With wide-open eyes
An increase in the wrinkles on the forehead	0.607	10.50	<0.001
DUES-like appearance	0.464	8.03	<0.001