遵义医科大学学报2026，Vol.49Issue(5)：532-544,13.
不同预测工具对心肺复苏后神经功能预后预测能力的比较:诊断试验网状Meta分析
Comparison of the predictive ability of different types of prediction tools for neurological function after cardiopulmonary resuscitation:a network Meta analysis of diagnostic tests
摘要
Abstract
Objective To systematically compare the predictive performance of different diagnostic tools for neu-rological outcome after cardiac arrest by integrating direct and indirect evidence through diagnostic test accuracy network Meta-analysis(DNMA).Methods Following PRISMA-DTA guidelines,we systematically searched Med-line,Embase,Web of Science,Cochrane Library,and Scopus from January 2020 to December 2025.Prospec-tive cohorts and retrospective studies providing 2×2 contingency table data with Cerebral Performance Category(CPC)as the reference standard were included.Bayesian hierarchical random-effects models were constructed into pool sensitivity,specificity,and diagnostic odds ratio(DOR).The surface under the cumulative ranking curve(SUCRA)was used to rank the predictive utility of each tool,and Bayesian selection models were applied to assess publication bias.Results A total of 13 studies(n=6 927)evaluating five predictive tools(AASSEP,MRI,NSE,EEG,and CT)and their subgroups were included.In the main analysis,AASSEP and MRI demon-strated the highest comprehensive diagnostic performance with DORs of 13.06(95％CI:7.74-21.12)and 7.82(4.58-12.47),and SUCRA values of 0.97 and 0.66,respectively.AASSEP showed high sensitivity(0.82,95％CI:0.75-0.88),while MRI exhibited superior specificity(0.82,0.75-0.87).CT displayed an extreme accuracy profile with specificity of 0.93(0.89-0.96)but sensitivity of only 0.19(0.14-0.26).The overall DORs for NSE and EEG were 5.41(3.92-7.46)and 6.65(4.70-9.24),respectively.Subgroup analyses revealed that NSE high-risk group(＞60 ng/ml)had a DOR of 38.30(19.01-77.18)with specificity of 0.71(0.59-0.81),whereas NSE low-risk group(＜33 ng/ml)showed high sensitivity of 0.89(0.81-0.94),suitable for early screening.The benign EEG pattern demonstrated a DOR of 2.34(1.53-3.60).Bayesian selection models indicated no significant publication bias(95％CI of β_selection for all tests included 0).Conclusion AASSEP and MRI possess the optimal comprehensive predictive power for neurological outcome after cardiac arrest;the former is more suitable for screening and the latter for confirmation.NSE high-risk group of-fers high confirmatory value for poor outcome,while low-risk group is appropriate for early exclusion.Clinical practice should avoid relying solely on medium-range NSE values or malignant EEG patterns,and adopt a multi-modal,staged assessment strategy.关键词
心脏骤停/自主循环恢复/网状Meta分析/预测价值/神经功能预后Key words
cardiac arrest/restoration of spontaneous circulation/network Meta analysis/predictive value/neurological prognosis分类
医药卫生引用本文复制引用
杨国盛,蔡亚林,叶青青,蒋雪梅,宋仁杰,喻安永,段海真..不同预测工具对心肺复苏后神经功能预后预测能力的比较:诊断试验网状Meta分析[J].遵义医科大学学报,2026,49(5):532-544,13.基金项目
国家自然科学基金资助项目(NO:82260385) （NO:82260385）
贵州省科技厅科技计划项目[NO:黔科合基础-ZK(2023)580] （2023）
贵州省卫生健康委科学技术基金资助项目(NO:gzwkj2023-103). （NO:gzwkj2023-103）
