PONE-D-21-35925Preoperative Neutrophil-Lymphocyte Ratio for Predicting Surgery-Related Acute Kidney Injury in Non-cardiac Surgery Patients under General Anaesthesia: A retrospective cohort studyPLOS ONE

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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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Reviewer #1: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Thanks to the authors for their efforts and for touching on an important issue in the practice of nephrology.

Although it is a retrospective study, it consolidates the increasing evidence of the utility of NLR in predicting AKI.

I have the following points:

1. Can the authors elaborate more on the pre-op creatinine values?

2. What do you think is the reason for the low specificity of 51.9%?

3. It would be better to mention data about the utility in Cardiovascular procedures, like CABG or repair of AA or in the HBP surgeries.

4. Authors should mention data, if any, about the use of NLR in the post-op setting to compare with their results.

4. It would be better to refer to the following paper, Chinese; with Meta-Analysis data:

Lu Z, Wang L, Jia L, Wei F, Jiang A. [A Meta-analysis of the predictive effect of neutrophil-lymphocyte ratio on acute kidney injury]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Mar;33(3):311-317. Chinese. DOI: 10.3760/CMA.j.cn121430-20201215-00755. PMID: 33834972.

5. The meta-analysis mentioned above has provided data about ethnic differences in NLR values (Asia vs. Eurasia). The authors can compare their cohort with the other groups

Reviewer #2: The neutrophil to lymphocyte ratio in various diseases had been discussed in detail in the past years. However, this important work is the first to suggest that it's preoperative value may predict postoperative AKI in non-cardiac surgery.

There are two papers that may increase the value of "Discussion" if mentioned.

The work of Yu Y, et al. described similar results, but the NLR was measured postoperatively in the first 24 hours. They studied a much smaller number of patients.

Yu Y, Cui WH, Cheng C, Lu Y, Zhang Q, Han RQ. Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy: A retrospective cohort study. World J Clin Cases. 2021 Dec 16;9(35):10816-10827. doi: 10.12998/wjcc.v9.i35.10816. PMID: 35047593; PMCID: PMC8678856.

The paper of Guangqing Z, et al. found the same result but in cardiac surgery. This recent paper probably was not published before the preparation of this paper.

Guangqing Z, Liwei C, Fei L, Jianshe Z, Guang Z, Yan Z, Jianjun C, Ming T, Hao C, Wei L. Predictive value of neutrophil to lymphocyte ratio on acute kidney injury after on-pump coronary artery bypass: a retrospective, single-center study. Gen Thorac Cardiovasc Surg. 2022 Feb 1. doi: 10.1007/s11748-022-01772-z. Epub ahead of print. PMID: 35103920.

A few spelling mistakes:

line 94: Diabetes;

line 136: Low;

line 142: Preoperative do not need capital letter.

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Reviewer #1: No

Reviewer #2: No

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Preoperative Neutrophil-Lymphocyte Ratio for Predicting Surgery-Related Acute Kidney Injury in Non-cardiac Surgery Patients under General Anaesthesia: A retrospective cohort study

PONE-D-21-35925R1

Dear Dr. Li,

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.

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Kind regards,

Giuseppe Filiberto Serraino, M.D., Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

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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 #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 #2: Yes

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

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 #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 #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 #2: Good revision. All comments have been addressed. The suggested literature was incorporeted and the spelling mistakes corrected.

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Reviewer #2: No

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