# Meta-analysis of 17 studies: larger optic nerve sheath diameter linked to poor outcome after cardiac arrest

- Published: 2026-11-11 16:54 UTC
- Section: Life & Health › Medicine
- Tags: optic nerve sheath diameter, ONSD, cardiac arrest, neurological outcomes, systematic review, meta-analysis, prognostic performance, sensitivity and specificity, publication bias
- URL: https://realtech.media/news/rt-bc8d5e5ea1e9f409c06af510_meta_analysis_of/

**A pooled analysis of 1,157 patients gave an AUC of 0.82 for optic nerve sheath diameter as a predictor of neurological outcome; the authors call it an adjunctive predictor.**

![Meta-analysis of 17 studies: larger optic nerve sheath diameter linked to poor outcome after cardiac arrest](https://realtech.media/media/2026/11/7e27eea5837cfe96.jpg)
*Pittigrilli, Wikimedia Commons, CC BY-SA 4.0*

A systematic review and meta-analysis published in BMC Emergency Medicine pooled 17 studies with a total of 1,157 cardiac arrest patients. It found that a higher optic nerve sheath diameter (ONSD) was associated with poor neurological outcome. The authors, Peng Yao Song, Shun Yi Feng and Yong Li, report an odds ratio of 8.97 (95% CI 5.51–14.61, P < 0.001) in a random-effects model [1].

Accurate prediction of neurological outcome after cardiac arrest remains clinically difficult. ONSD has emerged as a prognostic tool, but its reported performance varies across patient populations and methodological approaches [1]. The authors searched PubMed, Embase, the Cochrane Library, Web of Science, ScienceDirect and three Chinese databases from inception through March 2026, looking for studies that evaluated ONSD as a predictor of neurological outcome after cardiac arrest [1]. The review is registered in PROSPERO (CRD420261293166).

## Predictive performance of ONSD

The area under the curve (AUC) was 0.82 (95% CI 0.79–0.86) [1]. Pooled sensitivity was 72% (95% CI 63%–79%), and pooled specificity was 81% (95% CI 71%–89%) [1]. The authors also ran subgroup analyses, a sensitivity analysis and a publication-bias assessment. The association remained statistically significant in all predefined subgroups (all P < 0.01) [1].

## Heterogeneity and robustness checks

Between-study heterogeneity in the random-effects model was I2 = 48.7% (P = 0.013). Subgroup patterns suggested that sample size and study design may have contributed to it [1]. A leave-one-out sensitivity analysis supported the robustness of the pooled estimate [1].

Deeks' funnel plot asymmetry test suggested publication bias (P = 0.01). However, a trim-and-fill analysis indicated that the pooled estimate remained stable [1].

The authors conclude that ONSD may be a useful adjunctive predictor of neurological outcomes after cardiac arrest [1].

## Sources

1. [BMC Emergency Medicine](https://doi.org/10.1186/s12873-026-01790-7)
2. [bioengineer.org](https://bioengineer.org/higher-optic-nerve-sheath-diameter-associated-with-poor-cardiac-arrest-outcomes)

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Source: RealTech, realtech.media — https://realtech.media/news/rt-bc8d5e5ea1e9f409c06af510_meta_analysis_of/