PONE-D-20-02256

ASSOCIATION BETWEEN PREOPERATIVE LEVELS OF 25-HYDROXYVITAMIN D AND HOSPITAL-ACQUIRED INFECTIONS AFTER HEPATOBILIARY SURGERY.

PLOS ONE

Dear Dra Laviano,

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Dr. Sakamuri V. Reddy

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The authors have analyzed a large cohort of 301 patient population to evaluate the association between the levels of 25-OH vitamin D and hospital-acquired infections (HAIs) after hepatobiliary surgery. Specific comments and suggestions to further improve the manuscript are as follow. 1. Abstract- They have noted Discussion at the end, which needs to be replaced with “Conclusions” of the study. 2. (p.6; lines 133-139) delete the ‘title’ of the manuscript here. Also, given the previous studies in the field, the information provided “Introduction” needs to be detailed with more citations. Methods- clarify the statement that the study with patient population is approved with institutional IRB. Also, note separately a section of the “Statistical analysis” of the results. Also, note a separate paragraph on ‘vitamin D’ assays used to consider deficiency as per the American Endocrine Society guidelines (ex., citation #7) in Methods. Results- please provide a clear rationale of the study undertaken given other workers findings on the subject in the field.3. p.18; line 353-Remove citation name “Youssef et al” as it belongs only to citation #20, but it is noted as citations 6,17,20. Figure.1&2 embedded in the text are fine but seems repeated providing eps version again at the end after the References. Provide more details in the legends. I suggest the authors to follow journal article for style.

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4. At this time, we ask that you please provide additional informatino in your Methods section about the methodology used to conduct the chemiluminescent microparticle immunoassay (CMIA) to measure vitamin D concentrations in the patients serum samples.

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

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

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: This manuscript by Laviano et al. describes a significant link between preoperative Vitamin-D levels and the increased chance of developing nosocomial infections in patients undergoing hepatobiliary surgery. In general this manuscript is very well-written, easy to follow and its statistical analyses are pretty complete. I would only suggests a few minor additions to the text.

1) In line 161 authors refer previous studies similar to the submitted manuscript. It would be good to have a short explanation stating how this work in different to those.

2) In the legend of the first table the meaning of the abbreviations (ASA, COPD) is not included.

3) Better explanation of how the percentiles in table 1 were calculated is needed.

4) In line 235 authors mentioned Score II, but never mentioned this score in the manuscript. A brief explanation of what this means and why it is relevant to this work will be helpful to follow the manuscript.

5) In the third paragraph of the discussion is mentioned that other studies suggest a link between vit-D levels and heart disease. But this study does not observe statistical significance here. A possible reason for the different results should be included. Also the 4th paragraph of the discussion refers to 3rd paragraph (line 365) so the new paragraph is not really needed.

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Reviewer #1: No

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ASSOCIATION BETWEEN PREOPERATIVE LEVELS OF 25-HYDROXYVITAMIN D AND HOSPITAL-ACQUIRED INFECTIONS AFTER HEPATOBILIARY SURGERY:  A PROSPECTIVE STUDY IN A THIRD-LEVEL HOSPITAL

PONE-D-20-02256R1

Dear Dr. Laviano,

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.

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With kind regards,

Sakamuri V. Reddy, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: