Neuroprognostication After Cardiac Arrest Using Glial Fibrillary Acidic Protein: A Systematic Review and Meta-Analysis
Authors' conclusion
GFAP demonstrates time-dependent prognostic utility in predicting poor neurologic outcomes after cardiac arrest in adults, with optimal performance at 48-72 hours post-ROSC.
Study context
- Population
- Adults after cardiac arrest (in- or out-of-hospital) with return of spontaneous circulation (ROSC)20 studies
- Comparison
- Glial fibrillary acidic protein (GFAP) levels in poor vs good neurologic outcome after cardiac arrest
- Outcome
- Prognostic accuracy of GFAP for poor neurologic outcome
- Follow-up
- 24, 48 and 72 hours post-ROSC
Methodological detailsQUADAS-2 quality assessment, Low applicability concerns but moderate risk of bias in patient selection and flow/timing
- QUADAS-2 quality assessment
- Low applicability concerns but moderate risk of bias in patient selection and flow/timing
Pooled result
As reported in the abstract
Prognostic accuracy of GFAP for poor neurologic outcome (summary AUC)
- Summary AUC at 24 hours
- 0.76
- Summary AUC at 48 hours
- 0.84
- Summary AUC at 72 hours
- 0.88
- Median GFAP higher with poor neurologic outcome at 24 hours (Δ, pg/mL)
- 138.1
- Median GFAP higher with poor neurologic outcome at 48 hours (Δ, pg/mL)
- 471.1
- Median GFAP higher with poor neurologic outcome at 72 hours (Δ, pg/mL)
- 745.7
Further pooled results
Median GFAP difference, poor vs good neurologic outcome
pg/mL
- Higher median GFAP with poor outcome at 24 hours (Δ)
- 138.1
- Higher median GFAP with poor outcome at 48 hours (Δ)
- 471.1
- Higher median GFAP with poor outcome at 72 hours (Δ)
- 745.7
- Significantly higher
Subgroups: 6-month outcomes and OHCA (subgroup)
- Consistent results
Original publication
Neuroprognostication After Cardiac Arrest Using Glial Fibrillary Acidic Protein: A Systematic Review and Meta-Analysis. Crit Care Med. Published 15 January 2026. doi:10.
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