Peer Review History

Original SubmissionJune 2, 2020
Decision Letter - Muhammad Adrish, Editor

PONE-D-20-16666

Chest CT Findings Related to Mortality of Patients with COVID-19: A Retrospective Case-series Study

PLOS ONE

Dear Dr. Tao Ai,

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. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Muhammad Adrish

Academic Editor

PLOS ONE

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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: Partly

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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: 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: I read with interest the mansuscript. I find it well wrote.

Only some suggestions:

1. Introduction: -include data on COVID 19 global burden at the time of the revision

2. Methods: clear

3. Results: I appreciate a lot the results, the table and the figure. Well done!

4. Discussion: discuss about the future perspective from your data and cite this article ( Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health. 2020;17(8):2690. Published 2020 Apr 14.)

Reviewer #2: The manuscript entitled:"Chest CT Findings Related to Mortality of Patients with COVID-19: A Retrospective Case-series Study" is a retrospective study about the correllation between chest CT scan features, inflammatory serological markers and mortality rate in COVID-19 patients.

The questions are:

1) The Author reports an increase in neutrophyl/limphocites ratio near the death but does not specify the number of patients who had bacterial infection, can clarify please?

2) The Author reports the severity score of chest CT scan, can clarify the meaning of " severity score"?

3) What are the clinical signs of disease worsening as intended by the Author?

4) Why did the Author chose to measure the receptor of IL-2 as inflammatory marker?

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Reviewer #1: Yes: Francesco Di Gennaro

Reviewer #2: No

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Revision 1

Dear Dr. Muhammad Adrish (Academic Editor)

We appreciate the timely and thoughtful comments from you and the reviewers on our manuscript (PONE-D-20-16666) entitled "Chest CT Findings Related to Mortality of Patients with COVID-19: A Retrospective Case-series Study”. We thoroughly reviewed all comments and have carefully revised our manuscript accordingly.

Attached is our revised manuscript and detailed responses to the comments point by point. We hope that you will find our changes satisfactory.

Again, thank you very much and we look forward to hearing from you soon!

Sincerely,

TAO AI

====================================================================

Journal Requirements:

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Response: : Truly thank you for the comment. We have modified the article to meet PLOS ONE’s style requirements.

2.Please correct your reference to "p=0.000" to "p<0.001" or as similarly appropriate, as p values cannot equal zero.

Response: : Thank you for the comment. We have modified the P value in the article.

3.Thank you for stating the following in the Financial Disclosure section:

'The author(s) received no specific funding for this work.'

We note that one or more of the authors are employed by a commercial company: Julei Technology Company

Response: : Thank you for the comment. We decided to delete the author from our article, and thanks his contribution in Acknowledgement.

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Comments to the Author:

Reviewer #1

Introduction: -include data on COVID 19 global burden at the time of the revision

Response: : Truly thank you for the comment. The related information has been updated.

Methods: clear

Response: Thanks for your comment.

Results: I appreciate a lot the results, the table and the figure. Well done!

Response: Thanks for your comment.

Discussion: discuss about the future perspective from your data and cite this article ( Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health. 2020;17(8):2690. Published 2020 Apr 14.)

Response: Thanks for your comment. We discussed about the future perspective from your data and added the literature according your suggestion.

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Reviewer #2

The Author reports an increase in neutrophyl/lymphocites ratio near the death but does not specify the number of patients who had bacterial infection, can clarify please?

Response: Thanks for your concern. Yes,elevated Neutrophils, high sensitive CRP and decreased Lymphocytes were very common in patients with severe COVID-19, suggesting that second pulmonary bacterial infection plays an important role in the progression of the diseases (which may correlated with rapidly progressing lung consolidation/white lung). However, pathogen identification such as bacteria culture to confirm the infection of bacteria had been performed during the early time of the outbreak because of the long-time consumption of bacteria culture and potential risks when obtaining sputum specimens. Thus, in Chinese practice, early empirical treatment with antibiotics covering common pathogens was strongly suggested to be administered after analyzing clinical symptoms, and marked elevated levels of neutrophils and hs-CRP in serum, to prevent the occurrence of septic sepsis/multi-organ dysfunction .

The Author reports the severity score of chest CT scan, can clarify the meaning of " severity score"?

Response: Thanks for your comment. Severity score of chest CT means the range of lesions involvement. The higher the score, the wider the range of lesion involvement. The relevant content was mentioned in article, which appears in Materials and methods section CT image analysis: “Each of the five lung lobes was visually scored for the degree of lung involvements using a 4-point- scale: 0, no involvement; 1, 1-25% involvement; 2, 26%-49% involvement; 3, 50%-75% involvement; 4, 76%-100% involvement. The total severity CT score (the extent of pulmonary disease) was the sum of the five individual lobar scores and defined as follows: 0, none; 1-5, minimal; 6-10, mild; 11-15, moderate; and 16-20, severe involvement of the lung (white lung).” The method of severity score evaluated chest CT was from Bernheim [1].

[1] Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3):200463.

What are the clinical signs of disease worsening as intended by the Author?

Response: Thanks for your comment. In clinical aspect, the signs of disease worsening refers dyspnea that cannot be improved, irreversibly decreased blood oxygen saturation, decreased lymphocytes and increased level of inflammatory factors. In radiology aspect, the clinical signs of disease worsening are increased proportions of consolidation and increased chest CT severity scores.

Why did the Author choose to measure the receptor of IL-2 as inflammatory marker?

Response: Thanks for your comment. IL-2R, similar to TNF-α, IL-1β, IL-6 and IL-8, is a kind of inflammatory cytokines, which is a necessary signal for immune response. Meanwhile, pervious studies have demonstrated that the concentration of IL-2R was significantly changed in COVID-19 patients [2,3]. Therefore, we chose IL-2R.

[2] Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620-2629.

[3] Hou H, Zhang B, Huang H, et al. Using IL-2R/lymphocytes for predicting the clinical progression of patients with COVID-19. Clin Exp Immunol. 2020;201(1):76-84.

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Muhammad Adrish, Editor

Chest CT Findings Related to Mortality of Patients with COVID-19 : A Retrospective Case-series Study

PONE-D-20-16666R1

Dear Dr. Tao Ai,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Muhammad Adrish

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

**********

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: I appreciate a lot your paper

Authors improve their manuscript following reviewer suggestions

I think that is a good example of good interaction beetwen editor authors and reviewer

Congratulations

Reviewer #2: The Author replied satisfactorily to all questions and in my opinion the paper can be published in PlosOne journal

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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: Yes: Francesco Di Gennaro

Reviewer #2: No

Formally Accepted
Acceptance Letter - Muhammad Adrish, Editor

PONE-D-20-16666R1

Chest CT Findings Related to Mortality of Patients with COVID-19: A Retrospective Case-series Study

Dear Dr. Ai:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Muhammad Adrish

Academic Editor

PLOS ONE

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