Abstract：
Background and objectives: This study aims to evaluate the usefulness of the quantitative pupillary light reflex as a prognostic tool for neurological outcomes in post-cardiac arrest patients treated with targeted temperature management (TTM). Material and Methods: We systematically searched MEDLINE, EMBASE, and the Cochrane Library (search date: 9 July 2021) for studies on post-cardiac arrest patients treated with TTM that had measured the percent constriction of pupillary light reflex (%PLR) with quantitative pupillometry as well as assessed the neurological outcome. For an assessment of the methodological quality of the included studies, two authors utilized the prognosis study tool independently. Results: A total of 618 patients from four studies were included in this study. Standardized mean differences (SMDs) were calculated to compare patients with good or poor neurological outcomes. A higher %PLR measured at 0-24 h after hospital admission was related to good neurological outcomes at 3 months in post-cardiac arrest patients treated with TTM (SMD 0.87; 95% confidence interval 0.70-1.05; I2 = 0%). A higher %PLR amplitude measured at 24-48 h after hospital admission was also associated with a good neurological outcome at 3 months in post-cardiac arrest patients treated with TTM, but with high heterogeneity (standardized mean difference 0.86; 95% confidence interval 0.40-1.32; I2 = 70%). The evidence supporting these findings was of poor quality. For poor neurological outcome, the prognosis accuracy of %PLR was 9.19 (pooled diagnostic odds ratio, I2 = 0%) and 0.75 (area under the curve). Conclusions: The present meta-analysis could not reveal that change of %PLR was an effective tool in predicting neurological outcomes for post-cardiac arrest patients treated with TTM owing to a paucity of included studies and the poor quality of the evidence.
摘要：
背景和目的：本研究旨在评估定量瞳孔光反射作为心脏骤停患者的神经系统预后预测工具的有用性。材料与方法：我们系统地搜索了MEDLINE，EMBASE,和Cochrane图书馆(搜索日期:2021年7月9日)对心脏骤停后接受TTM治疗的患者进行研究,这些患者通过定量瞳孔测量法测量了瞳孔光反射收缩百分比(%PLR),并评估了神经系统结局.为了评估纳入研究的方法学质量，两位作者独立使用了预后研究工具.结果：共有来自四项研究的618例患者被纳入本研究。计算标准化平均差异（SMD）以比较神经系统预后良好或不良的患者。入院后0-24小时测得的较高的PLR与接受TTM治疗的心脏骤停患者在3个月时的良好神经系统预后有关（SMD0.87；95％置信区间0.70-1.05；I2=0％）。在接受TTM治疗的心脏骤停患者中，入院后24-48小时测得的较高的PLR幅度也与3个月时良好的神经系统预后相关。但具有高度异质性（标准化平均差0.86；95％置信区间0.40-1.32；I2=70％）。支持这些发现的证据质量很差。对于糟糕的神经系统结果，%PLR的预后准确性为9.19(合并诊断比值比，I2=0%)和0.75(曲线下面积)。结论：目前的荟萃分析无法揭示，由于纳入的研究少，证据质量差，%PLR的变化是预测TTM治疗后心脏骤停患者神经系统预后的有效工具。
