PONE-D-19-21935

Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis

PLOS ONE

Dear Mingqing,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. A major concern is that

your study did not compare the predictive effects of different nutritional assessment methods on surgical risk/clinical outcomes. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please be informed that the revision does not guarrantee the acception for publication.

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Dong-Xin Wang

Academic Editor

PLOS ONE

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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: Partly

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?

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Reviewer #1: Yes

Reviewer #2: No

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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 current manuscript, the authors evalued the nutritional status of 93 HAE patients retrospectively, to find a concise and reasonable nutritional evaluation indicator to serve the clinical preoperative risk assessment. And the results of the study showed that NRS 2002 may be more reliable and prudent than that of BMI or ALB level in judging malnutrition in HAE patients, and the nutritional status of HAE patients is related to many clinical factors, such as Child-Pugh classification of liver function, size of lesion, ALB and so on. The authors concluded that NRS 2002 is more suitable for preoperative risk assessment for HAE patients.

Overall, the current manuscript showed us some impressive information, e.g. "malnutrition is common in HAE patients", "compared to BMI and ALB, NRS 2002 can help diagnose more malnutrition in HAE patients".

However, there are still some issues that must be clarified to support the current conclusion drawn from the available results:

1. The purpose of the current study was to "find a concise and reasonable nutritional evaluation indicator" to find out the HAE patients with malnutrition, which could help serve the clinical preoperative risk assessment better, to guide preoperative nutritional support treatment and to reduce the risk of surgery for treatment of HAE. However, in the current study they did not compare the predictive effects of different nutritional assessment methods on surgical risk. It seems that they just considered NRS 2002 as the gold standard for diagnosis of malnutrition.

2. As mentioned before, no comparison was made to evaluate the predictive effects of different nutritional assessment methods (e.g. BMI, ALB, NRS 2002) on surgical risk of HAE, why the authors concluded that "NRS 2002 is more suitable for preoperative risk assessment for HAE patients"? Although NRS 2002 could diagnose more malnutrition patients than the other methods, this also means that with this indicator more HAE patients were not suitable for direct surgical treatment, unless a preoperative nutritional support was introduced. Is this consistent with the current status of HAE treatment (about 36.56% of the HAE patients should receive preoperative nutritional support before operation)? If so, the authors should state that point to emphasize the significance of this study, otherwise the results should be reinterpreted carefully, that maybe ALB or BMI, but not NRS 2002, is more suitable for preoperative risk assessment for HAE patients.

Reviewer #2: Xie et al. in their manuscript entitled "Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis" reported preoperative nutritional evaluation for patients with hepatic alveolar echinococcosis (HAE). This is a large sample-size research, as the HAE is rare disease and malnutrition did not get much attention for the investigators. The authors found malnutrition is common event, and several evaluation methods had subtle difference. While, several minor concerns may need to be addressed:

1. It is important to analysis the hemoglobin, wound complications and hospital stay for malnutrition patients.

2 As the present study enrolled 93 patients, it would be interesting if the author stratify those patients into the poor nutrition and good nutrition groups.

3. The conclusion should be more concise to show the goal of this study.

4. The abbreviations should be spelt out in full name the first time. This manuscript needs to be polished by an English-native speaker.

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Reviewer #1: Yes: Yinmo Yang

Reviewer #2: No

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Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis

PONE-D-19-21935R1

Dear Dr. Xu Mingqing,

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,

Dong-Xin Wang

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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: All my comments have been fully addressed, and the current manuscript looks to meet the publication requirements.

Reviewer #2: The authors have satisfactorily addressed the comments and the manuscript has been improved in the revised manuscript.

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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