Key result
qPLR outperforms NPi for post-arrest neurological prognostication, linked to ~24-fold higher odds of favorable outcome.
Why the study?
The performance of quantitative pupillary light reflex and neurological pupil index for predicting neurological outcomes in cardiac arrest patients was unclear and required systematic evaluation.
Does the quantitative pupillary light reflex improve diagnostic accuracy in predicting favorable neurologic outcomes compared to the neurological pupil index in post-cardiac arrest patients?
Meta-Analysis (n=1,530)
Yes
Does the quantitative pupillary light reflex improve diagnostic accuracy in predicting favorable neurologic outcomes compared to the neurological pupil index in post-cardiac arrest patients?
Odds Ratio: 24.5 (95% CI 13.08–45.86)
p-value: p=<.001
The quantitative pupillary light reflex is a robust, non-invasive prognostic tool that provides superior diagnostic accuracy over the neurological pupil index for predicting neurologic outcomes after cardiac arrest.
Supports qPLR over NPi for post-arrest prognostication; extends observational data via meta-analytic confirmation.
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.
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Chang Feng (2025) conducted a meta-analysis in Cardiac arrest (n=1,530). Quantitative pupillary light reflex (qPLR) vs. Neurological pupil index (NPi) was evaluated on Neurological outcome assessed via Glasgow-Pittsburgh Cerebral Performance Categories (favorable vs unfavorable) (OR 24.50, 95% CI 13.08-45.86%, p=<.001). The quantitative pupillary light reflex (qPLR) demonstrated greater diagnostic accuracy (AUC 0.89) and was strongly associated with neurological outcome (OR 24.50) compared to the neurological pupil index.
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