Peer Review History

Original SubmissionMay 31, 2021
Decision Letter - Andrea Ballotta, Editor
Transfer Alert

This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present.

PONE-D-21-17952

Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention

PLOS ONE

Dear Dr. aires,

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Andrea Ballotta

Academic Editor

PLOS ONE

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“The study was supported by Conselho Nacional de Desenvolvimento Científico e 557 Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior 558 (CAPES), the Hospital Universitário de Brasília (HUB-EBSERH) from Universidade de 559 Brasília (UnB) and Hospital Regional da Asa Norte (HRAN).”

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 “The authors are grateful for the financial support provided by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). LAN, MSG, OTN, WF and OAMF thank CNPq for the PQ fellowship program. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

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6. Please amend the manuscript submission data (via Edit Submission) to include author Alexandre A. de S. M. Soares, Ana Paula M. Gomides, André M. Nicola, Andrea Teixeira-Carvalho, Dayde Lane M. da Silva, Eliana T. de Gois, Flávia D. Xavier, Francielle P. Martins, Gabriela P. J. Santos, Heidi Luise Schulte, Isabelle S. Luz, Laila S. Espindola, Laurence R. do Amaral, Liza F. Felicori, Luciana A. Naves, Maíra R. M. de Carvalho, Matheus de S. Gomes, Otávio T. Nóbrega, Patrícia Albuquerque, Wagner Fontes, Ciro M. Gomes, Patricia S. Kurizky1, Cleandro P. Albuquerque, Olindo A. Martins-Filho and Licia Maria H. da Mota.

Additional Editor Comments:

The paper needs major revision

[Note: HTML markup is below. Please do not edit.]

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

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

Reviewer #1: I Don't Know

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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: 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

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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 this work, the authors aimed to give their contribution to the assessment of the viscoelastic methods, in particular thromboelastometry ROTEM, in the COVID-19 setting with the addition of a statistical model for the stratification of the disease severity based on selected thromboelastometric values. The employment of the NATEM test in the study evaluation represents the very novelty point in comparison to what have been done previously by the other research groups.

My major issue concerning this study is the initial stratification of the patients operated by the authors. In the previous published research regarding the topic, it was cleared that the most important differences for thromboelastometric evaluation were present between the critical patients (admitted to ICU, on mechanical ventilation) vs. non critical subjects (that could be patients admitted to regular ward or on home therapy, but more frequently hospitalized). When critically ill patients were analyzed together with the non-critical ones the differences were smaller or became non-significant. In the light of this, I wander how the series of the authors would react to a further stratification of the Severe group into critical (points 4 and 5 of the criteria) and non-critical. Moreover, it may be interesting to add platelet count to the decision tree algorythm because it's another important parameter contributing to the prothrombotic evolution in the COVID-19 positive patients.

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Reviewer #1: No

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Revision 1

Dear editors

This document is intended to provide responses to each point addressed by the Journal and Reviewers.

The authors would like to thank for all the suggestions made, including the inclusion of our protocol in the protocol repository: protocols.io (dx.doi.org/10.17504/protocols.io.bwvbpe2n)

Journal Requirements

1. Re-checked PLOS ONE´s style requirements.

We found some situations where the Journal´s style requirements were not met. All of those were corrected.

2. We decided to avoid Written Consent as the risk of manipulating objects between healthy and sick individuals could, theoretically, increase the viral transmission in the institution.

So, the use of digital consent was requested and approved by our ethic review board, namely CONEP (Comissão Nacional de Ética em Pesquisa).

Both informations were included in the manuscript, in the Methods section.

3. Amended the information included in the Funding Statement so it is the same mentioned in the Financial Disclosure.

4. The new text with Funding Statement was included at the end of the Cover Letter, as requested.

5. To a complete understanding of the results and conclusions made in the paper, all data were made available: not only in graphic visualization, but also in a Supporting Table with all averages, standard deviation and p values.

As suggested, we also uploaded all raw data to a public repository, namely Harvard Dataverse: https://doi.org/10.7910/DVN/NWSVZA

6. All authors were included in the Manuscript Submission Data.

Reviewer responses to Questions

1. Reviewer #1 answered positively; nothing to change.

2. Our statistical analysis was planned by three senior authors. Author MSG and LRA are both mathematicians at UFU (Federal University of Uberlandia) and actually work with the development of machine learning algorithms. Besides them, OAMF is a senior researcher with great expertise in bio-statistics and mathematic models of generalizability. They have been working together planning and participating in many studies involving the necessity of advanced mathematic evaluations. After that, other two authors, CPA and OTN, two researchers specially involved with statistical analysis, validated and re-tested all the data obtained in this study.

Besides that, all our raw data and statistical analysis are available in the public repository Harvard Dataverse (DOI included in the Supporting information): https://doi.org/10.7910/DVN/NWSVZA

3. All our raw data are public and there isn´t any objection to make it available. For the understanding of the results and conclusions made in the paper, the data included are enough, as we included not only the p value, but also, means and standard deviation. We understand that it may be more difficult to visualize the numbers just in the graphics, but in the S1 Table, all the numbers are available and may easily be accessed and analyzed.

If it is not enough, it will be a pleasure for us to provide access to all raw data (Public repository Harvard Dataverse): https://doi.org/10.7910/DVN/NWSVZA

4. Reviewer #1 answered positively; nothing to change.

5.

Thank you very much for the suggestion.

At the time of the research we were faced with the necessity of stratifying our patients. At that time, a used guideline available was published by the WHO and separated individuals using the criteria selected in this study. As the time passed, possibily we would use other criteria, but at that time, it was a reasonable one.

Besides the novel use of NATEM in general COVID patients, other important topic in our study was the finding that even nonsevere patients already have hemostatic alterations, especially in NATEM. Moreover, the original description of TPI (thrombodynamic index) is other strong fact in our study. This parameter, as NATEM CT, also maintained the alterations described even when not separating the COVID-19 patients.

Thinking in this perspective, even with more strict criteria it probably wouldn’t modify the results, as both groups, nonsevere and severe, showed endogenous activation, represented by shorter CT in NATEM. Moreover, TPI probably wouldn´t also be altered by more strict criteria for classifying patients as severe.

We respectfully consider that even changing the classification criteria, our findings justify the publication and highlight more aspects of this challenging disease. After all, we have commented in the discussion that our sample size wouldn’t be able to detect different severities in the severe group.

The suggestion of adding platelet count is very good also; unfortunately, it was not available in most of our patients. As these patients are from public service hospitals, even simple exams may be unavailable at some periods. That was the case during the inclusion period: platelets, d-dimers and even creatinine were unavailable and so, not considered for the mathematic models.

6. Reviewer #1 answered positively; nothing to change.

We hope that our answers are appropriate, but we are completely available to explain any other detail or doubt that may appear.

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Andrea Ballotta, Editor

Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention

PONE-D-21-17952R1

Dear Dr. aires,

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,

Andrea Ballotta

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

On the basis of the reviewer's evaluation after your response and my judgement i deem the paper "Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention" suitable for publication

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

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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

**********

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

Reviewer #1: I Don't Know

**********

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

**********

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

**********

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 observations and suggestions have been addressed thourougly. I have no further issues with this submission.

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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

Formally Accepted
Acceptance Letter - Andrea Ballotta, Editor

PONE-D-21-17952R1

Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention

Dear Dr. Aires:

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. Andrea Ballotta

Academic Editor

PLOS ONE

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