Reply to “Use of Serum Neuron-Specific Enolase Level to Predict Adverse Neurologic Outcomes after Aortic Surgery”
07 February 2019
11 March 2019
19 April 2019 (online)
We appreciate the authors' comments on neurologic injury of our study.
First, the authors are interested to know whether all of adverse postoperative neurologic outcomes were attributable to brain injury. In this study, all of adverse postoperative neurologic outcomes were attributed to brain injury. Five temporary neurologic dysfunction patients had delirium, and seven permanent neurologic dysfunction patients had cerebral infarction. Moreover, authors are concerned about the relationship between serum neuron-specific enolase (NSE) levels and spinal cord injury. There was no spinal cord injury in this study series. Therefore, we cannot provide the required relations. However, localization of NSE may be related to spinal cord injury.
Second, the cutoff value of serum NSE level was 34.14 ng/mL for neurologic injury. The positive predictive value is 62.5%, the negative predictive value is 92.5%, and Youden index is 0.62. The cutoff value of serum NSE level was 43.56 ng/mL for permanent neurologic dysfunction. The positive predictive value is 57.1%, the negative predictive value is 94.3%, and Youden index is 0.963.
Finally, the concept of ΔNSE is very interesting. Another study including coronary artery bypass grafting and valve procedure is ongoing. We think that this concept will add to the investigation of this study.