External validation of geriatric influenza death score: A multicenter study

Yuan Kao; Wei-Jing Lee; Kang-Ting Tsai; Chung-Feng Liu; Chien-Chin Hsu; Hung-Jung Lin; Chien-Cheng Huang; How-Ran Guo

doi:10.1371/journal.pone.0283475

Peer Review History

Original SubmissionJune 18, 2022
21 Jul 2022 Decision Letter - Muhammad Tarek Abdel Ghafar, Editor PONE-D-22-17460External validation of geriatric influenza death score: a multicenter studyPLOS ONE Dear Dr. Huang, 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. Please submit your revised manuscript by Sep 01 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. [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 Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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 ****** 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: Please correct the typos Please describe the population so that one gets a feel of comorbidity. What was the average stay in hospital? what % died within 30 days but after discharge in previous studies comparing percentages of the outcome does not give a correct position of reality. for example 38%of deaths were among the old elderly but the denominator is smaller than the other groups Being retrospective- did you have any missing data? Reviewer #2: The original sent for my review is a retrospective validation of a risk prediction rule for identifying older patients at risk of mortality from flu. The authors involved in the first description are now involved in this external validation The results of their work showed that this GID does identify patients at a higher risk of mortality from flu, showing a lower mortality rates for different cut offs compared to those previously published. The work is well done but need some clarifications by the authors to improve its overall quality. - The main concerns come from the definition of disease (in the previous paper was fever+ identification of flu in nasal swabs whereas in this case it is influenza diagnosis or prescription of common anti flu drugs) and the different outcomes (which is recognized by the authors as a limitation). However, how can they be confident that those patients who went to the ED and discharged to home did not die? There is no reason to use all those who did not die in the hospital or were discharged to be supposed not to die. - Another concern comes from the different epidemics within the time range that could have biased the results (more aggressive variants, different vaccination %). Could the authors provide some data regarding this concern? ****** 6. 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: Evans Amukoye Reviewer #2: Yes: Bernardino Alcazar ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0283475.r001
Revision 1
20 Jan 2023 Author Response Response to the Reviewers’ comments (Manuscript ID: PONE-D-22-17460) Thank you very much for giving us the opportunity to revise the manuscript for your reconsideration of publication in the PLOS ONE. According to the valuable comments and suggestions from the reviewer, we revised the manuscript and indicated the changes in red and line number. In addition, we prepared a “Response to Reviewers’ Comments” which includes point-by-point responses to each reviewer as the follows. Editorial office 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: We have revised the manuscript according to your suggestions. 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. Response: We have ensured the grant information we provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections does match in the revision. 3. Thank you for stating the following in the Acknowledgments Section of your manuscript: "This study was supported by Grant CMNCKU10816 and Grant CMHCR10954 from Chi Mei Medical Center." We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: "NO. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." Please include your amended statements within your cover letter; we will change the online submission form on your behalf. Response: We have deleted the funding in the manuscript and added funding statement “This study was supported by Grant CMNCKU10816 and Grant CMHCR10954 from Chi Mei Medical Center. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” to the cover letter according to your suggestion. 4. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. Response: We have revised the Availability of data and materials as “Because the data contain potentially sensitive information, derived data supporting the findings of this study are available from the Institutional Review Board of Chi Mei Medical Center on request (contact information: https://www.chimei.org.tw/main/cmh_department/59024/indexInternet.htm).” In addition, the above statement was added to the cover letter. Reviewer #1: 1. Please correct the typos. Response: We thank the Reviewer’s reminding and have checked and corrected the typos through the whole manuscript. 2. Please describe the population so that one gets a feel of comorbidity. What was the average stay in hospital? what % died within 30 days but after discharge in previous studies comparing percentages of the outcome does not give a correct position of reality. for example 38%of deaths were among the old elderly but the denominator is smaller than the other groups. Response: We thank the Reviewer’s comment regarding describing the study population and added “The study population is Tainan city, which had about 1.8 million of people and 17.3% of them were age ≥65 years until December 31, 2021 [5].” to describe the population in the Methods of the revised manuscript (line 93-95). We added “The average stay in hospital was 7.2 ± 7.5 days.” into the Results of the revised manuscript (line 150-151). Because we were interested in in-hospital mortality in this study, we did not include 30-day mortality in all patients, including the patients who were discharged. To explain the reason, we added “The original measurement of outcome in the GID score is 30-day mortality. Because we were interested in in-hospital mortality, we chose to use this measurement of outcome in this study. The patients who were discharged from the ED and had no record of mortality in the electronic medical record were also defined as survival.” to the Measurement of outcome (line 115-119) and “The measurement of outcome was in-hospital mortality in this study, which is different from 30-day mortality in the original study for developing GID score. The difference of disease definition and outcome measurement between two studies may contributed to a lower accuracy in this study. However, the result of this study for predicting in-hospital mortality could provide an important reference for validating GID score for different outcome. Because we had no data about the percentage of death within 30 days after discharge, further study about this issue is needed.” to the limitations of the revised manuscript (line 239-245). We agree with the Reviewer’s comment regarding that outcome does not give a correct position of reality. Therefore, we added “The average mortality rate was highest in the old elderly (5.2%, 47/902), followed by the moderate elderly (2.2%, 50/2234) and the young elderly (1.0%, 24/2372).” to the Results of the revised manuscript to make it clearer (line 145-147). 3. Being retrospective- did you have any missing data? Response: We thank the Reviewer’s comment regarding the missing data and added “Because this study is retrospective and missing data is unavoidable in the real world, we chose to give normal values to fill the missing data of Glasgow coma scale, bandemia, and hs-CRP.” to the Statistics (line 136-138) and “The missing data and given values are listed in the Supplementary Table 1.” to the Results of the revised manuscript (line 154-155). Reviewer #2: 1. The main concerns come from the definition of disease (in the previous paper was fever+ identification of flu in nasal swabs whereas in this case it is influenza diagnosis or prescription of common anti flu drugs) and the different outcomes (which is recognized by the authors as a limitation). However, how can they be confident that those patients who went to the ED and discharged to home did not die? There is no reason to use all those who did not die in the hospital or were discharged to be supposed not to die. Response: We agreed with the Reviewer’s comment regarding the definition of disease and the different outcomes and added “Second, the definition of disease in the previous paper was presence of fever and identification of flu in nasal swabs whereas in this case it is influenza diagnosis or prescription of common anti-flu drugs. The measurement of outcome was in-hospital mortality in this study, which is different from 30-day mortality in the original study for developing GID score. The difference of disease definition and outcome measurement between two studies may contributed to a lower accuracy in this study. However, the result of this study for predicting in-hospital mortality could provide an important reference for validating GID score for different outcome. Because we had no data about the percentage of death within 30 days after discharge, further study about this issue is needed.” to the limitations of the revised manuscript (line 235-244). In addition, we added “The original measurement of outcome in the GID score is 30-day mortality. Because we were interested in in-hospital mortality, we chose to use this measurement of outcome in this study.” to the Measurement of outcome to explain why we chose in-hospital mortality as the outcome in this study (line 115-117). To response to another concern for the definition of mortality, we added “The patients who were discharged from the ED and had no record of mortality in the electronic medical record were also defined as survival.” to the Measurement of outcome of the revised manuscript (line 117-119). 2. Another concern comes from the different epidemics within the time range that could have biased the results (more aggressive variants, different vaccination %). Could the authors provide some data regarding this concern? Response: We thank the Reviewer’s comment regarding different epidemics within the time range that could have biased the results. We revised the sentences as “First, there were different epidemics within the time range that could have biased the results. The major circulating viruses were influenza A (H1N1) in 2009, 2010, 2015, and 2018; influenza A (H3N2) in 2012, 2013, 2014, and 2016; and influenza B in 2011 and 2017 [19].” in the limitations of the revised manuscript (line 232-235). https://doi.org/10.1371/journal.pone.0283475.r002
9 Mar 2023 Decision Letter - Muhammad Tarek Abdel Ghafar, Editor External validation of geriatric influenza death score: a multicenter study PONE-D-22-17460R1 Dear Dr. Huang, 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 Tarek Abdel Ghafar, M.D 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 ******** 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 am comfortable with authors response. This tool may require further validations before recommending wide use. Reviewer #2: The authors have assessed the main concerns from this reviewer properly. They gave reasonable explanations of the outcome assessment and posible biases from the study ****** 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: Yes: Bernardino Alcazar-Navarrete ******** https://doi.org/10.1371/journal.pone.0283475.r003
Formally Accepted
16 Mar 2023 Acceptance Letter - Muhammad Tarek Abdel Ghafar, Editor PONE-D-22-17460R1 External validation of geriatric influenza death score: a multicenter study Dear Dr. Huang: 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 Prof Muhammad Tarek Abdel Ghafar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0283475.r004

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