PONE-D-19-26678

MULTIMORBIDITY GENDER PATTERNS IN HOSPITALIZED ELDERLY PATIENTS.

PLOS ONE

Dear DR ALMAGRO,

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PLOS ONE

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Additional Editor Comments (if provided):

The authors evaluate differences in patterns of multimorbidity by gender in this population and their possible prognostic implications defined as in-hospital mortality, 1-month readmissions, and 1- year mortality in 843 patients with well-established multimorbidity criteria admitted to a specific unit for chronic complex care patients. Multimorbidity criteria, Charlson, PROFUND and Barthel indexes, and Pfeiffer test were collected prospectively during admission. Women were older, with greater functional dependence , more cognitive deterioration ], and worse scores on the PROFUND In the multimorbidity criteria scale, heart failure, autoimmune diseases, dementia, and osteoarticular diseases were more frequent in women, while ischemic heart disease, chronic respiratory diseases, and neoplasms predominated in men. In the analysis of grouped patterns, neurological and osteoarticular diseases were more frequent in females, while respiratory and cancer predominated in males. We did not find gender differences for in-hospital mortality, 1- month readmissions, or 1-year mortality. In the multivariate analysis age, Charlson, Barthel and PROFUND indexes, alongside previous admissions, were independent predictors of 1-year mortality, while gender was non-significant.

The manuscript is very interesting. I have only a minor concern. No mention about the prevalence and incidence of syncope that is well known to influence mortality and disability in older adults. Do you have any data about this matter. Please see and discuss Ungar A et al. Two-year morbidity and mortality in elderly patients with syncope. Age Ageing. 2011 Nov;40(6):696-702.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In the manuscript entitled Multimorbidity gender patterns in hospitalized elderly patients, Almagro P. and co-authors report on the assessment of differences in patterns of multimorbidity by gender in a cohort of elderly patients and their possible prognostic implications defined as in-hospital mortality, 1-month readmissions, and 1-year mortality. To this aim Authors focused on a cohort of 843 elderly patients in which, based on the multimorbidity criteria scale, heart failure, autoimmune diseases, dementia, and osteoarticular diseases were more frequent in women, and ischemic heart disease, chronic respiratory diseases, and neoplasms predominated in men. Then the Authors grouped multimorbidity patterns and found that neurological and osteoarticular diseases were more frequent in females, while respiratory and cancer predominated in males but didn’t find gender-related differences for in-hospital mortality, 1-month readmissions, or 1-year mortality. Finally, in the multivariate analysis age, comorbidity indexes, with previous admissions, were independent predictors of 1-year mortality. The Authors conclude that different patterns of multimorbidity by gender, with greater functional impairment in women and more comorbidity in men exist, although without prognosis differences.

Overall, this is an interesting manuscript reporting on an intriguing topic. The aim is clear, and the analysis is well conducted and reported. I only have minor concerns about the role of clinical frailty, which the authors only mentioned in the abstract and in the introduction section, but did not explore as a variable in the analysis of comorbidities. Finally, the manuscript needs native English review and there are several typing errors.

For this reason, I don’t consider the manuscript suitable for publication as is stands.

Reviewer #2: The research aim was to evaluate differences in patterns of multimorbidity by gender in 843 patients admitted to a specific unit for chronic complex care patients and in-hospital mortality, 1-month readmissions, and 1-year mortality. Multimorbidity criteria, Charlson, PROFUND and Barthel indexes, and Pfeiffer test were collected prospectively during admission. 49.2% were men, with a median age of 84 years. Women were older, with greater functional dependence more cognitive deterioration and worse scores on the PROFUND index while men had more comorbidity measured with the Charlson index. In the multimorbidity criteria scale, heart failure, autoimmune diseases, dementia, and osteoarticular diseases were more frequent in women, while ischemic heart disease, chronic respiratory diseases, and neoplasms predominated in men. In the analysis of grouped patterns, neurological and osteoarticular diseases were more frequent in females, while respiratory and cancer predominated in males. We did not find gender differences for in-hospital mortality, 1- month readmissions, or 1-year mortality. In the multivariate analysis age, Charlson, Barthel and PROFUND indexes, alongside previous admissions, were independent predictors of 1-year mortality, while gender was non-significant. Charlson and PROFUND indexes predicted mortality during follow-up more accurately in men than in women (AUC 0.70 vs. 0.57 and 0.74 vs. 0.62), respectively, with both p<0.001.

The study is well conducted, data support conclusions. The manuscript is well written.

Figure 4 should be modified. Le legend is h and m and should be translated in English. The number of subject at risk should be described. The intervals should be 0 – 90 - 180 -270 – 360.

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Reviewer #1: No

Reviewer #2: No

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MULTIMORBIDITY GENDER PATTERNS IN HOSPITALIZED ELDERLY PATIENTS.

PONE-D-19-26678R1

Dear Dr. ALMAGRO,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Pasquale Abete

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

No further comments.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have addressed all the comments. The manuscript is now suitable for publication in PLOS ONE.

Reviewer #2: All comments have been addressed. The manuscript is improved and in my opinion is suitable for publication..

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No