PONE-D-23-04816Combined Evaluation of Geriatric Nutritional Risk Index and Neutrophil to lymphocyte ratio for Predicting All-cause mortality and cardiovascular mortality in Hemodialysis PatientsPLOS ONE

Dear Dr. Wang,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Make revisions in accordance with the reviewers, please.

I invite to respond the comments of the reviewers. the paper will be reconsidered if adequately revised.

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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: 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: 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: Introduction; I advise authors to make it clear why they studied NLR in hemodialysis patients as a risk factor for CV mortality. Chronic kidney disease is associated with low grade inflammation (). On the other hand, NLR is associated with various inflammatory conditions such as pancreatitis (Iran J Colorectal Res 2022;10(3):75-86.), diabetes mellitus type 2 (African health sciences, 19(1), 1602-1606), autoimmune disorders (Revista da Associação Médica Brasileira, 63, 1065-1068), and thyroid conditions (Ethiop. J. Health Dev. 2021; 35(3):149-153). Inflammation involve in all of these diseases similar to the chronic kidney disease.

Materials&Methods; An inclusion criteria was noted as Age≥18. However, mean age was 63 years. Please revise.

Results and Discussion; fair enough

Reviewer #2: 1. the title is not well worded and too long ("All-cause mortality and cardiovascular mortality"?????)

2. Abstract: in Introduction add: "Aim of the study was To investigate the predictive value of the.........."

3. Abstract: methodology - this sentence do not belong here: "COX regression analysis showed that GNRI and NLR were risk factors for death in MHD patient" same one is in the Results section too.

4. Improve English

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-04816R1Combined Evaluation of Geriatric Nutritional Risk Index and Neutrophil to lymphocyte ratio for Predicting All-cause mortality and cardiovascular mortality in Hemodialysis PatientsPLOS ONE

Dear Dr. Wang,

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 Jul 16 2023 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Gulali Aktas

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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: I Don't Know

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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

**********

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: Dear Author

You have mentioned a very good topic in your article but background must be improved. NLR is a novel marker of inflammation derived from routine blood count test. Its association with inflammation has been reported in inflammatory bowel disease (Wiener klinische Wochenschrift (2015)127:262-265. DOI 10.1007/s00508-014-0683-5), diabetes mellitus (Afri Health Sci. 2019;19(1):1602-1606. DOI: 10.4314/ahs.v19i1.35), and gastrointestinal conditions (Iran J Colorectal Res. 2022;10(3):75-86. doi: 10.30476/ACRR.2022.97244.1160). Improve the background please.

Best Regards...

Reviewer #2: - In Abstract section, please write full terms for NLR and GNRI.

- In Results section, for number of patients (50 and 29) except total number write values in percentages (%)

- Three last sentences in Introduction should be written on better way and they should have better formulation in context of Introduction ("No studies have used GNRI and NLR combinations to predict prognosis in MHD patients. GNRI and NLR are clinically relevant indicators of mortality in MHD patients and contribute to early diagnosis and intervention. The study was based on data from two hemodialysis centers, focusing on the impact of GNRI and NLR on all-cause mortality in MHD patients."

- "The study was based on data from two hemodialysis centers" - this information should be part of Materials and Methods

- In Materials and Methods section write the type of the study

- Inclusion and Exclusion criteria should include more information about patients

- What about Inform consent of the patients? Did you provide it?

- In Methods section include formula for NLR calculation

- In Materials and Methods section include information about all parameters that you was analyzed in the study and explain (for example: hemoglobin, blood phosphorus, platelet-lymphocyte ratio(PLR)...)

- In Statistical processing section, explain how you determined correlation between two variables (Did you use Pearson or Sperman correlation coefficient?)

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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

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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.

Combined Evaluation of Geriatric Nutritional Risk Index and Neutrophil to lymphocyte ratio for predicting all-cause and cardiovascular mortality in hemodialysis patients

PONE-D-23-04816R2

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,

Gulali Aktas

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Authors

You responded the editorial and reviewers' comments adequately. There is nothing more that need further revision. Thank you.

Reviewers' comments: