Performance of the quantitative pupillary light reflex and neurological pupil index for predicting neurological outcomes in cardiac arrest patients: A systematic review and meta-analysis.

BACKGROUND

The performance of quantitative pupillary light reflex (qPLR) and the neurological pupil index (NPi) was used to predict neurological outcomes in cardiac arrest (CA) patients.

METHODS

Eligible studies on the ability of the qPLR and NPi to predict neurological outcomes in CA patients were searched from the PubMed and China National Knowledge Infrastructure databases until July 2023. The pooled odds ratio (OR) and its 95% confidence interval (95% CI), area under the curve, sensitivity analysis, and publication bias were analyzed via Stata 14.0 software.

RESULTS

Twelve studies involving 1530 CA patients (968 in the qPLR study and 1025 in the NPi study) satisfied the inclusion criteria. qPLR (OR: 24.50, 95% CI: 13.08-45.86%, P < .001) and NPi (OR: 15.55, 95% CI: 7.92-30.55%, P < .001) were significantly associated with neurological outcome. The pooled area under the curves of the qPLR and NPi for predicting neurological outcome were 0.89 (95% CI: 0.86-0.92%) and 0.66 (95% CI: 0.62-0.70%), respectively. The pooled results were robust according to the sensitivity analysis. The funnel plots for qPLR (P = .94) and NPi (P = .10) did not reveal any publication bias.

CONCLUSION

Compared with the NPi, the qPLR has greater diagnostic accuracy in predicting favorable neurologic outcomes.