Evaluation of the therapeutic efficiency and efficacy of blood purification in the treatment of severe acute pancreatitis

Hongwei Huang; Zhongshi Huang; Menghua Chen; Ken Okamoto

doi:10.1371/journal.pone.0296641

Peer Review History

Original SubmissionJuly 24, 2023
13 Nov 2023 Decision Letter - Chiara Lazzeri, Editor PONE-D-23-23277Evaluation of the Therapeutic Efficiency and Efficacy of Blood Purification in the Treatment of Severe Acute PancreatitisPLOS ONE Dear Dr. Okamoto, 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 Dec 28 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. 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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 2. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ Additional Editor Comments: the present investigation deals with a hot topic. It is well designed however some issues can be rasied. We suggest to add information on patients with septic shock, on the causes of septic shock (in particular microorganisms involved), antibiotics used (and wether serum concentrations varied between the two subgroups). Mechanism(s) responsible for the different incidence of AKI should be hypothesized. An English mother-tongue expert should revise the manuscript [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: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know 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: No 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: 1.Is the unit of creatinine level “mmol/L” or“umol/L” 2.Please add the cause of pancreatitis like “Gallstones,Alcohol abuse,Hyperlipidemia” in the baseline character. 3.In table 3 there was statistically significant difference in 1-year all-cause mortality between two groups(P=0.04).What is the 1-year survival curves between two groups? 4 The English in this paper should be improved. I recommend the authors have it checked by a native speaker of English familiar with this field. Reviewer #2: Overall, the data presented in the manuscript supports the similar findings described by other groups demonstrating limited effects of hemofiltration (ultrahemofiltration/dialysis) on the clinical course and outcomes of SIRS, sepsis, severe acute pancreatitis, etc. The main drawback of the paper that it is not really an original research but rather a statistical analysis of the retrospective data from Medical Information Mart for Intensive Care IV (MIMIC IV) database provided by Beth Israel Deaconess Medical Center (Boston, Massachusetts, USA). Based on the methodology and the content of the paper, I believe, this manuscript should be targeted towards more specialized journal with the lower impact factor. I would also suggest changing the term "blood purification" into an appropriate medical term - hemodialysis, veno venous hemofiltration, etc. ****** 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: No Reviewer #2: No ******** [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. Attachments Attachment Submitted filename: review.docx https://doi.org/10.1371/journal.pone.0296641.r001
Revision 1
5 Dec 2023 Author Response Response to Reviewers December 4, 2023 RE: Manuscript Number PONE-D-23-23277 Dear editor, Thank you for granting us the opportunity to submit a revised version of the manuscript “Evaluation of the Therapeutic Efficiency and Efficacy of Blood Purification in the Treatment of Severe Acute Pancreatitis”. Thanks to the reviewers and editors for their thoughtful comments on our manuscript. The suggested modifications are presented in the manuscript in trace mode, and a clean version was submitted without any revision marks. The reviewers' and editorial remarks and recommendations are also addressed below point by point. In addition, we also asked professional native editors to polish the language of our article. Once again, we are grateful to the reviewers and editors for their valuable comments and suggestions and look forward to your response. Please do not hesitate to contact us with any questions. Sincerely, Ken Okamoto Point-by-point reply to Reviewers' comments Reviewers' comments: Reviewer #1: 1. Is the unit of creatine level “mmol/L” or “μmol/L”? Response: Thank you for pointing this out. We agree with the Reviewer and have made changes, we have used μmol/L. See lines 86, 97, and 99. 2. Please add the cause of pancreatitis like “Gallstones, Alcohol abuse, Hyperlipidemia” in the baseline character. Response: Thank you for this suggestion. Demographic information on etiology of AP is added to the Methods section, see line 106. The relevant expression “The Etiology of AP included cholelithiasis (72 cases), alcohol abuse (158 cases), hypertriglyceridemia (64 cases), and others (11 cases).” has been added to the baseline characteristics of the Results part, see lines 147-148, and see Table 1 for specific data. 3. In table 3 there was statistically significant difference in 1-year all-cause mortality between two groups (P=0.04).What is the 1-year survival curves between two groups? Response: Thank you for pointing this out. There is no significant statistical difference in both the 28-day and 1-year all-cause mortality between the two groups. The value from 1 year was a simple oversight, this issue has been rectified (p = 0.114) instead of (p = 0.04). See Table 3. 4. The English in this paper should be improved. I recommend the authors have it checked by a native speaker of English familiar with this field. Response: Thank you for this suggestion. This article has been carefully revised by professional native English editors to improve the language level and readability. Reviewer #2: Overall, the data presented in the manuscript supports the similar findings described by other groups demonstrating limited effects of hemofiltration (ultrahemofiltration/dialysis) on the clinical course and outcomes of SIRS, sepsis, severe acute pancreatitis, etc. The main drawback of the paper that it is not really an original research but rather a statistical analysis of the retrospective data from Medical Information Mart for Intensive Care IV (MIMIC IV) database provided by Beth Israel Deaconess Medical Center (Boston, Massachusetts, USA). Based on the methodology and the content of the paper, I believe, this manuscript should be targeted towards more specialized journal with the lower impact factor. I would also suggest changing the term "blood purification" into an appropriate medical term - hemodialysis, veno venous hemofiltration, etc. Response: Thank you for your suggestion. Hemodialysis and hemofiltration are blood purification techniques (PMID: 37388799). In this paper, we explored the overall effect of blood purification on pancreatitis, as the patients used for this study underwent different types of blood purification treatments such as intermittent hemodialysis, continuous veno-venous hemofiltration, and an unknown form of BP (lines 216-217). Therefore blood purification was appropriately used to encompass all the different methods. Furthermore, many published articles use the term blood purification in their studies similar to our own (PMID: 30896634). (PMID: 35791651) lists hemofiltration as a type of blood purification treatment. Point-by-point reply to editorial comments: The present investigation deals with a hot topic. It is well designed however some issues can be rasied. 1. We suggest to add information on patients with septic shock, on the causes of septic shock (in particular microorganisms involved), antibiotics used (and wether serum concentrations varied between the two subgroups). Response: Thank you for your suggestion. The relevant information (lines 294-298) has been added to the manuscript, as follows: The development of septic shock in SAP is caused by the necrotizing pancreatic tissue [32]. The tissue may become infected by bacteria with the usual culprits being Staphylococcus aureus, but mainly Pseudomonas and Escherichia coli. Sepsis is usually treated with Carbapenems (imipenem/cilastatin, meropenem, doripenem, biapenem or panipenem) [4] and vasopressor therapy [33]. The references involved are as follows: 4. Mao E. Intensive management of severe acute pancreatitis. Ann Transl Med. 2019; 7(22): 687. doi: 10.21037/atm.2019.10.58 32. Mifkovic A, Pindak D, Daniel I, Pechan J. Septic complications of acute pancreatitis. Bratisl Lek Listy 2006; 107(8): 296-313. 33. Hamzaoui O, Goury A, Teboul JL. The Eight Unanswered and Answered Questions about the Use of Vasopressors in Septic Shock. J Clin Med 2023; 12(14): 4589. doi: 10.3390/jcm12144589 In addition, the data from this study was obtained from a publicly available database. The data did not explicitly state that the patients developed septic shock, we surmised that they had shock based on the use of vasopressors. 2. Mechanism(s) responsible for the different incidence of AKI should be hypothesized. Response: Thank you for this suggestion. The patients from the control group had a lower comorbidity index and lower incidence of AKI than the group receiving BP treatment, the patients in the BP group usually had a more advanced SAP hence the need for BP treatment, and AKI is a major complication of SAP. The relevant contents (lines 237-242) are as follows: About 64.7% of the BP group had chronic kidney disease (compared to 22.4% in the control group), and 30 patients had an acute worsening of chronic kidney function (defined as a serum creatinine increase of more than 1.5 times above the baseline) underwent BP treatment (24 people did not receive BP). Presumably, AKI is the main complication of SAP [20], and renal dysfunction or deterioration may lead to the requirement of BP treatment application in these patients. The reference involved is as follows: 20. Kinjoh K, Nagamura R, Sakuda Y, Yamauchi S, Takushi H, Iraha T, Idomari K. Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis. Acute Crit Care 2022; 37(3): 398-406. doi: 10.4266/acc.2022.00192 It should be noted that there is a large difference in the baseline between the two groups. See lines 163-164 and 235-237. 3. An English mother-tongue expert should revise the manuscript. Response: Thank you for this suggestion. We have requested help regarding this issue and hopefully, it will be rectified. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0296641.r002
18 Dec 2023 Decision Letter - Chiara Lazzeri, Editor Evaluation of the Therapeutic Efficiency and Efficacy of Blood Purification in the Treatment of Severe Acute Pancreatitis PONE-D-23-23277R1 Dear Dr. Okamoto, 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, Chiara Lazzeri Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0296641.r003
Formally Accepted
28 Dec 2023 Acceptance Letter - Chiara Lazzeri, Editor PONE-D-23-23277R1 PLOS ONE Dear Dr. Okamoto, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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. Chiara Lazzeri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0296641.r004

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