PONE-D-20-21885

The risk factors for mortality of diabetic patients with severe COVID-19: a retrospective study of 167 severe COVID-19 cases in Wuhan

PLOS ONE

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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: 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: No

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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: The manuscript is well written and technically sound with good statistical analysis and would make it's contribution to the ongoing battle against COVID-19. However, it requires few correction before it can be accepted for publication. There are few typo and grammatical errors and the discussion should be modified with the two articles that I recommend by comparing them with your results. See the corrections in the PDF attachment.

Reviewer #2: In this article, the authors reviewed the records of 167 patients with severe COVID-19 who were hospitalized at Tongji Hospital in Wuhan China between late January and early March of 2020. Of these patients they identified 55 who had diabetes and 112 who did not.

Baseline demographics and admission laboratory data were compared between the patients with and without diabetes which showed significant differences in multiple categories including age, wehigth blood cell counts, albumin and multiple inflammatory and, particularly, cardiac markers.

Mortality rates were significantly higher in patients with diabetes (80% vs 58%). In a univariate analysis comparing patients who did and did not survive COVID-19 multiple markers were disproportionately elevated in both those with and without diabetes. These meaningful indicators were included in a multivariate COX regression model which determined cutoffs for lymphocyte counts, LDH, hsCRP, and IL-10 which were predictive of survival/mortality. Patients who had more than one abnormality had higher mortality rates.

This manuscript provides novel data regarding inflammatory markers in patient with severe COVID-19 and while the overall trends in markers are similar between those with and without diabetes the multivariate cutoffs could be useful comparisons for future research.

Some additional clarity regarding the methods and data would provide readers more context.

Were the 167 patients with severe COVID-19 all of the patients with that condition seen between January and March or were some excluded? On page 6 it is mentioned that “we included 167 patients with complete data…” If some patients were excluded due to incomplete data, the methods of how this was decided should be outlined.

Additionally, the specific criteria used to classify patients as “severe” COVID-19 should be outlined as reference 4 is in Chinese and would not be readable by most of the readership of PLOS One. If these criteria are different than what is currently used as an international standard these differences and their implications should be summarized as well.

Figure 1 shows differences between laboratory values at admission and discharge/death, but these data at the time of discharge/death do not appear to be presented elsewhere in tables or analysis. The study otherwise appears focused on laboratory values on admission. Was a comparison of these makers performed between patients with and without diabetes who died/survived?

Was any analysis performed regarding the degree of glycemic control during admission for patients with diabetes? This would be a very clinically relevant comparison and of interest to readers. If the focus is risk determined solely by laboratory values on admission, that is a reasonable analysis, but it should be more clearly stated.

The values for interleukin-1beta in the tables are all listed as 5, I suspect this was entered in error.

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Reviewer #1: Yes: Adekunle Sanyaolu

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-20-21885 (Covid 19).pdf

The risk factors for mortality of diabetic patients with severe COVID-19: a retrospective study of 167 severe COVID-19 cases in Wuhan

PONE-D-20-21885R1

Dear Dr. Zhang,

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.

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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

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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

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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: There is a typo correction for you to fix.

Discussion, Page 15: Place the comma after '2' in the number 7,2314 to read 72,314.

Reviewer #2: The author's clarifications have answered all of my questions. I think this does provide usefull data regarding the correlation between inflammatory makers and outcomes in COVID-19 from early in the pandemic and should be published.

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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