Neuroprognostication After Cardiac Arrest Using Glial Fibrillary Acidic Protein: A Systematic Review and...

Area of Science:

• Neurology
• Biomarkers
• Critical Care Medicine

Background:

• Cardiac arrest survivors face significant risks of poor neurologic outcomes.
• Accurate prognostication is crucial for guiding clinical decisions and resource allocation.
• Glial fibrillary acidic protein (GFAP) is an emerging biomarker for brain injury.

Purpose of the Study:

• To systematically evaluate the prognostic accuracy of glial fibrillary acidic protein (GFAP) levels.
• To assess GFAP's predictive performance for poor neurologic outcomes in adult cardiac arrest patients.
• To determine the optimal time window for GFAP measurement post-resuscitation.

Main Methods:

• A systematic review and meta-analysis of studies measuring GFAP in cardiac arrest patients.
• Inclusion of randomized controlled and observational studies reporting neurologic outcomes.
• Data extraction and quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Main Results:

• Twenty studies were included, with 12 contributing to meta-analyses.
• Significantly higher GFAP levels were observed in patients with poor neurologic outcomes at 24, 48, and 72 hours post-ROSC.
• Prognostic accuracy, measured by area under the curve, improved over time, reaching 0.88 at 72 hours.

Conclusions:

• GFAP demonstrates time-dependent prognostic utility for predicting poor neurologic outcomes after cardiac arrest.
• Optimal prognostic performance of GFAP is observed between 48-72 hours post-ROSC.
• GFAP shows potential as an investigational biomarker, requiring further prospective studies for validation and standardization.