Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery

Liqiang Wang; Zhibang Zhao; Wenliang Fan; Yuan Yao; Qingbo Chu

doi:10.1371/journal.pone.0303067

Peer Review History

Original SubmissionAugust 12, 2023
7 Nov 2023 Decision Letter - Victor Afamefuna Egwuonwu, Editor PONE-D-23-24968Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery.PLOS ONE Dear Dr. Chu, 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 provide feedback on how your calculated your sample size and include location of your study. Please submit your revised manuscript by Dec 22 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. 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If your ethics statement is written in any section besides the Methods, please delete it from any other section. 4. Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure. 5. 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. Additional Editor Comments: Dear Authors, Please attend to reviewer one concern as quickly as you can and send modification for final consideration. Thank you and best wishes 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: 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: No 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: The article expressed original thoughts with most of the various subsections involved in scientific work given. However, the sample size used for the research was missing including the location of the study otherwise a good article. Reviewer #2: The manuscript was well-written however, I have one question regarding anthropometric measurements choices utilised in your research they did not include central obesity measure will this not have affected your outcome and does it mean that all your subjects have no obese individual from the start to finish the observational study. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
16 Nov 2023 Author Response Responses to editors Thank you for your comments and tips concerning our manuscript. We would respond to reviewers and submit the revised manuscripts according to your prompts. Thank you. According to the journal requirements, we have edited our manuscript to meet PLOS ONE’s style requirements, and the ORCID would be updated in EM system. Moreover, the duplicated ethics statement has been deleted in our revised manuscript, and the reference to Figure 1 was also added. Lastly, the reference list has also been checked. Responses to reviewer 1 The article expressed original thoughts with most of the various subsections involved in scientific work given. However, the sample size used for the research was missing including the location of the study otherwise a good article. Response: Thank you for your kind comments. Our study included 544 individuals, and this study was conducted at the Emergency Trauma Center of Nanyang Second People’s Hospital. Due to the nature of observational study, we may not control the sample size accurately after following up. Therefore, we set a minimum sample size by calculating the minimum sample size required for multivariable regression. This study included 8 anthropometric measurements variables, and we calculated the sample size by (events per variable) EPV method. EPV = number of events / number of variables When the EPV > 10, the multivariable models could be considered being stable. Therefore, the sample size was least 80 for events group [1]. Moreover, according to the similar studies in hip fractures, the sample size of our study (544 individuals) was also satisfactory [2]. More discussion of sample size and location of this study have added to our study (Method and Result part). [1] Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007 Mar 15;165(6):710-8. doi: 10.1093/aje/kwk052. Epub 2006 Dec 20. PMID: 17182981. [2] Liu M, Chu Q, Yang C, Wang J, Fu M, Zhang Z, Sun G. The paradoxical relation between serum uric acid and outcomes of hip fracture in older patients after surgery: A 1-year follow-up study. Surgery. 2022 Nov;172(5):1576-1583. doi: 10.1016/j.surg.2022.07.008. Epub 2022 Aug 26. PMID: 36031447. Responses to reviewer 2 The manuscript was well-written however, I have one question regarding anthropometric measurements choices utilised in your research they did not include central obesity measure will this not have affected your outcome and does it mean that all your subjects have no obese individual from the start to finish the observational study. Response: Thank you for your valuable advice. We have to admit that we cannot included all central obesity measures in our study. However, we believe some of measurements may be used as central obesity measures, such as waist circumference, thigh circumference, and suprailiac skinfold. Moreover, many studies used waist circumference as an index of central fatness [1]. Therefore, we believe the waist circumference in our study may be considered as a central fatness measure. [1] Jayedi A, Soltani S, Zargar MS, Khan TA, Shab-Bidar S. Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies. BMJ. 2020 Sep 23;370:m3324. doi: 10.1136/bmj.m3324. PMID: 32967840; PMCID: PMC7509947. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0303067.r002
14 Dec 2023 Decision Letter - Amir Human Hoveidaei, Editor PONE-D-23-24968R1Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery.PLOS ONE Dear Dr. Chu, 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 Jan 28 2024 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, Amir Human Hoveidaei Academic Editor PLOS ONE Additional Editor Comments (if provided): Dear authors, Please follow the reviewer comments and revise the paper for a re-evaluation. [Note: HTML markup is below. Please do not edit.] 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 Reviewer #3: (No Response) ******** 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 Reviewer #3: No ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 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 Reviewer #3: 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 Reviewer #3: No ****** 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: The author has provided answers to concerns raised: sample size as well as the study location have been satisfactory stated. Reviewer #2: I have accepted the response from the Authors and which to recommend the acceptance of the manuscript for publication. Reviewer #3: After careful evaluation, I find that this manuscript currently falls short of the standards required for publication. The study presents an interesting concept, but there are significant concerns regarding clarity, methodology, and analysis which need to be addressed. Abstract: The results and conclusion sections of the abstract are rather confusing. It would be beneficial to restructure these sections for better clarity and coherence, ensuring that key findings and implications are presented in a straightforward manner. Introduction: The language used in the introduction is problematic, with notable issues of redundancy and unclear phrasing. A thorough revision to improve the language and eliminate repetitive statements is necessary to enhance the quality and readability of this section. Methods: The study exhibits a considerable loss to follow-up (33%, including lost data), which could introduce significant bias into the conclusions. It's crucial to address this issue and discuss its potential impact on the study's validity. The decision to separate analyses by sex to reduce gender bias is noted. However, it seems that incorporating these variables into regression models could further minimize bias. Could you please explain the rationale behind not using such methods in your analysis? Results: The tables would benefit from including the number of patients involved in each specific analysis. This addition would greatly assist in understanding the scope and applicability of the findings. Determining and specifying a cut-off value for each measurement under study would significantly enhance the interpretative value of the results. Consideration should be given to including more variables in your models, such as sex, height, weight, BMI, age, etc., to provide a more comprehensive analysis. ****** 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: Yes: Dr Ulu O Ulu Reviewer #2: No Reviewer #3: 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. https://doi.org/10.1371/journal.pone.0303067.r003
Revision 2
18 Dec 2023 Author Response Response Letter Manuscript ID number: PONE-D-23-24968 Title: Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery Dear Editors and Reviewers, Thanks very much for taking the time to review this manuscript. We appreciate all your generous comments and suggestions! Changes to our manuscript have been highlighted by using colored text in the revised manuscript. Please find our response below and my revisions in the re-submitted files. Responses to editors Thank you for your comments and tips concerning our manuscript. We would respond to reviewers and submit the revised manuscripts according to your prompts. Thank you. Responses to Reviewer 1 The author has provided answers to concerns raised: sample size as well as the study location have been satisfactory stated. Response: Thank you for your kind comments. I'm glad to hear that the concerns raised regarding the sample size and study location have been satisfactorily addressed. Responses to Reviewer 2 The author has provided answers to concerns raised: sample size as well as the study location have been satisfactory stated. Response: Thank you for recommending the acceptance of the manuscript for publication. We are grateful for your support. Responses to Reviewer 3 Abstract: The results and conclusion sections of the abstract are rather confusing. It would be beneficial to restructure these sections for better clarity and coherence, ensuring that key findings and implications are presented in a straightforward manner. Response: Thank you for your valuable advice. The abstract has been revised as follows: [Background: We aimed to explore the predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery. Methods: Eight common anthropometric measurements, including arm circumference (AC), waist circumference (WC), thigh circumference (TC), calf circumference (CC), biceps skinfold (BS), triceps skinfold (TS), suprailiac skinfold (SIS), and subscapular skinfold (SSS), were included to identify their predictive value in survival and free walking ability of geriatric hip fractures. The results of anthropometric measurements were compared between patients with different outcomes. Cox and logistics models were established to further identify the predictive value of anthropometric measurements. Results: Comparison among groups indicated that individuals with different outcomes may have significantly different anthropometric measurements. In the Cox analyses based on all individuals, all models proved that the patients with higher AC, as well as CC and BS, may have a lower risk of 1-year mortality. Similarly, in the logistics analysis, AC, CC, and BS were proven to have strong predictive ability for 6-month and 1-year mortality in females and overall individuals. However, the predictive value of the eight common anthropometric measurements in free walking ability is not significant. Conclusion: AC, CC, and BS may have strong predictive ability for 6-month and 1-year mortality in all individuals and females.] Introduction: The language used in the introduction is problematic, with notable issues of redundancy and unclear phrasing. A thorough revision to improve the language and eliminate repetitive statements is necessary to enhance the quality and readability of this section. Response: Thank you for your valuable advice. The introduction part has been revised thoroughly with the help of native English speakers to enhance the quality and readability. This part has been revised as follows: [Hip fractures, occurring in the proximal femur, are commonly considered one of the most dangerous fractures in elder adults [1]. These fractures are primarily caused by low-energy trauma, often resulting from falls, while the root causes are age-related factors such as impaired balance, muscle weakness, and decreased bone mineral density [2]. Geriatric hip fractures are associated with high morbidity and mortality rates [3], primarily due to pre-existing comorbidities, surgical complications, and postoperative immobility [4]. Common complications include surgical site infections, urinary tract infections, venous thromboembolism, pressure ulcers, pneumonia, and delirium. Nutrition status is a major risk factor for the outcomes of hip fractures and significantly impacts the rehabilitation of geriatric hip fractures [5]. Adequate nutrition is essential for bone regeneration, tissue repair, immune function, and wound healing, all of which may reduce the incidence of complications and improve the prognosis of geriatric hip fractures [6]. However, malnutrition as a common concern in older adults may contribute to poor healing, increased complications, prolonged recovery, low survival, and high disability following a hip fracture [7]. Assessing and addressing the nutritional needs in older adults with hip fractures is vital to improving their outcomes [5]. Anthropometric measurements, such as arm circumference, waist circumference, and others, can reflect an individual's nutritional status [8]. Poor anthropometric measurements are often associated with malnutrition, which can negatively impact the healing process and functional recovery in geriatric hip fracture patients. These anthropometric measurements provide valuable information about body composition and can assist healthcare professionals in assessing the nutritional needs of older adults with hip fractures. In this study, eight common anthropometric measurements, including arm circumference (AC), waist circumference (WC), thigh circumference (TC), calf circumference (CC), biceps skinfold (BS), triceps skinfold (TS), suprailiac skinfold (SIS), and subscapular skinfold (SSS), were included to identify their predictive value in survival and free walking ability of geriatric hip fractures.] Methods: The study exhibits a considerable loss to follow-up (33%, including lost data), which could introduce significant bias into the conclusions. It's crucial to address this issue and discuss its potential impact on the study's validity. Response: Thank you for your valuable advice. We noted that the high rate of loss to follow-up may cause bias in our study. However, we have tried our best to control the sample size in this study. Assuming that loss to follow-up is a random event, if the sample size is sufficient, the patients who are not lost to follow-up can adequately represent all patients. We believe that the bias introduced by loss to follow-up should also be controllable. Similarly, previous studies have also reported similar rates of loss to follow-up (PMID: 36510169, 36127624). More discussion about this issue has been added to the limitation part in our revised manuscript. The following part has been added to our revised manuscript: [Firstly, as an observational study, this study had data loss and loss to follow-up, which may introduce bias into our findings. However, we have tried our best to control the sample size in this study. Assuming that loss to follow-up is a random event, if the sample size is sufficient, the patients who are not lost to follow-up can adequately represent all patients. We believe that the bias introduced by loss to follow-up should also be controllable.] The decision to separate analyses by sex to reduce gender bias is noted. However, it seems that incorporating these variables into regression models could further minimize bias. Could you please explain the rationale behind not using such methods in your analysis? Response: Thank you for your valuable comments. We noticed that we forgot to state the specific variables for each model in the manuscript. In fact, in the Cox and logistic regression models, we have included the variables that showed significant differences in the univariate analysis. The included variables are age, sex (in models for all individuals only), BMI, and fracture type (femur neck and intertrochanteric). This variable selection approach is also commonly used in most literature, as it allows for the inclusion of relevant variables while ensuring model stability. We decided to conduct a gender subgroup analysis because we realized that differences in body measurements between different genders could lead to bias. Discrepancies in cutoff points, averages, and other measurements could potentially impact the outcomes. As a result, we chose to conduct a gender subgroup analysis to better understand how these differences may influence the results. More description of the variables in multivariable models has been added to our revised manuscript. The following part has been added to our revised manuscript: [Age, sex (in models for all individuals only), BMI, and fracture type were included in the Cox models 1 and 2 as co-variables. Age, sex (in models for all individuals only), BMI, and fracture type were included in the multivariable logistics models 1 and 2 as co-variables.] Results: The tables would benefit from including the number of patients involved in each specific analysis. This addition would greatly assist in understanding the scope and applicability of the findings. Response: Thank you for your valuable advice. Added accordingly. Please see the tables in our revised manuscript. Determining and specifying a cut-off value for each measurement under study would significantly enhance the interpretative value of the results. Response: Thank you for your valuable advice. We added an independent part for ROC curves to our study, and the detailed results of ROC analysis, including AUROC, 95%CI, potential cutoff values, and p values, have been added to our revised manuscript (Table 4 and supplementary table 11). Related descriptions have also been added to our revised manuscript. The following parts have been added to our revised manuscript: [Similar to Cox models, the logistics modes 1 and 2 were also established by adjusting for all types or single type of anthropometric measurements, respectively. ROC curves were established to evaluate the predictive values and to determine the potential cut-off values for each measurement. To avoid the bias caused by sex, the analyses were also performed in males and females separately.] [Predictive values of anthropometric measurements ROC curves were established to determine the predictive values and the potential cutoff values of anthropometric measurements for mortality and free walking ability. The multivariable analysis indicated the predictive ability of AC, CC, and BS, so we summarized their detailed results of ROC curves in Table 4. The detailed results of ROC analyses for all anthropometric measurements, including AUC, 95%CI, potential cutoff values, and p values, were summarized in Supplementary table 11. Similarly, the AC, CC, and BS showed significant predictive values for 1-year mortality in all individuals and females, while no significant results in males. For 1-year free walking ability, AC was proven to have significant predictive ability in all individuals and females, and CC was only proven in all individuals, while no significant results of BS were proven. The potential cutoff values of each anthropometric measurement have been summarized in Table 4 and supplementary table 11. Table 4: Results of ROC analysis for AC, CC, and BS. All individuals 1-year mortality 1-year free walking ability AUC(95% CI) Cutoff values p AUC(95% CI) Cutoff values p AC 0.595 (0.529, 0.661) 21.88 0.002 0.568 (0.513, 0.623) 28.155 0.008 CC 0.597 (0.528, 0.667) 29.61 0.001 0.571 (0.514, 0.627) 29.625 0.007 BS 0.591 (0.526, 0.656) 13.005 0.003 0.523 (0.465, 0.581) 13.035 0.791 Males 1-year mortality 1-year free walking ability AUC(95% CI) Cutoff values p AUC(95% CI) Cutoff values p AC 0.556 (0.426, 0.687) 23.25 0.156 0.556 (0.451, 0.661) 26.295 0.87 CC 0.581 (0.459, 0.702) 29.59 0.074 0.664 (0.564, 0.763) 29.65 0.001 BS 0.600 (0.488, 0.712) 13.01 0.964 0.539 (0.440, 0.639) 13.165 0.786 Females 1-year mortality 1-year free walking ability AUC(95% CI) Cutoff values p AUC(95% CI) Cutoff values p AC 0.617 (0.542, 0.691) 28.245 0.002 0.575 (0.510, 0.640) 28.31 0.015 CC 0.608 (0.523, 0.694) 29.395 0.004 0.524 (0.455, 0.594) 23.19 0.76 BS 0.589 (0.508, 0.670) 12.98 0.014 0.517 (0.445, 0.589) 12.98 0.686 Note: AC: arm circumference, CC: calf circumference, BS: biceps skinfold.] [Supplementary table 11: Detailed information of ROC curves; Supplementary table 12: Raw data of our study.] Consideration should be given to including more variables in your models, such as sex, height, weight, BMI, age, etc., to provide a more comprehensive analysis. Response: Thank you for your valuable advice. We noticed that we forgot to state the specific variables for each model in the manuscript. In fact, in the Cox and logistic regression models, we have included the variables that showed significant differences in the univariate analysis. The included variables are age, sex (in models for all individuals only), BMI, and fracture type (femur neck and intertrochanteric). This variable selection approach is also commonly used in most literature, as it allows for the inclusion of relevant variables while ensuring model stability. More description of the variables in multivariable models has been added to our revised manuscript. The following part has been added to our revised manuscript: [Age, sex (in models for all individuals only), BMI, and fracture type were included in the Cox models 1 and 2 as co-variables. Age, sex (in models for all individuals only), BMI, and fracture type were included in the multivariable logistics models 1 and 2 as co-variables.] Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0303067.r004
26 Feb 2024 Decision Letter - Amir Human Hoveidaei, Editor PONE-D-23-24968R2Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery.PLOS ONE Dear Dr. Chu, 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 Apr 11 2024 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, Amir Human Hoveidaei Academic Editor PLOS ONE Additional Editor Comments (if provided): Dear authors Many thanks for your submission Based on the reviewer’s comments I recommend major revision Best, AHH [Note: HTML markup is below. Please do not edit.] 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 #4: 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 #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: No ****** 4. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #4: 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 #4: I had the opportunity to review this interesting manuscript on the accuracy of common anthropometric measures to predict the outcome of hip fracture surgery in elderly population. The manuscript is well-written overall and employs a relatively sound methodology. I have some comments to enhance the methodology and quality of the presentation, which you can find below. a. Line 93; Please further elaborate on how CCI is calculated and interpreted. b. Please describe a summary of participants’ characteristics (at least their age and gender) in the first paragraph of the results section. c. Table 1 may be somewhat misleading, and I recommend omitting it. Since males and females possess distinct anthropometric characteristics, aggregating them to assess the association between anthropometric measures and outcomes is not advisable. Tables 2 and 3 effectively convey the relationship between these measures and the outcome. I recommend a similar approach and omitting the aggregated section of Table 4, Figure 2, and Figure 3. d. Please add a conclusion section at the end of the discussion section. ****** 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. 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Revision 3
28 Feb 2024 Author Response Response Letter Manuscript ID number: PONE-D-23-24968 Title: Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery Dear Editors and Reviewers, Thanks very much for taking the time to review this manuscript. We appreciate all your generous comments and suggestions! Changes to our manuscript have been highlighted by using colored text in the revised manuscript. Please find our response below and my revisions in the re-submitted files. Responses to editors Thank you for your comments and tips concerning our manuscript. We would respond to reviewers and submit the revised manuscripts according to your prompts. Thank you. Responses to Reviewer 4 a. Line 93; Please further elaborate on how CCI is calculated and interpreted. Response: Thank you for your valuable advice. More description on CCI has been added to our revised manuscript. The following part has been added to our revised manuscript: [CCI is a widely used tool in medical research and clinical practice to quantify the burden of comorbidities in patients. The index takes into account 19 different conditions, such as heart disease, diabetes, and cancer, and assigns a score ranging from 1 to 6 to each condition based on its severity and impact on mortality [9]. The items and their weights were summarized in Supplementary table 1. 9. Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother Psychosom. 2022;91(1):8-35. Epub 20220106. doi: 10.1159/000521288.] b. Please describe a summary of participants’ characteristics (at least their age and gender) in the first paragraph of the results section. Response: Thank you for your valuable advice. Added accordingly. The following part has been added to our revised manuscript: [The mean age of the study population was 72.38 ± 10.47 years, and the mean BMI was 21.77 ± 4.27 kg/m2. More female participants (374, 68.75%) were included in this study than males (170, 31.25%).] c. Table 1 may be somewhat misleading, and I recommend omitting it. Since males and females possess distinct anthropometric characteristics, aggregating them to assess the association between anthropometric measures and outcomes is not advisable. Tables 2 and 3 effectively convey the relationship between these measures and the outcome. I recommend a similar approach and omitting the aggregated section of Table 4, Figure 2, and Figure 3. Response: Thank you for your valuable advice. These tables and figures have been revised accordingly. The updated Tables 1, 2, and 3 were the previous Tables 2, 3, and 4. The previous table 1 has been added to supplementary tables. d. Please add a conclusion section at the end of the discussion section. Response: Thank you for your valuable comments. Added accordingly. The following part has been added to our revised manuscript: [Conclusion The predictive value of the eight common anthropometric measurements in elderly male patients after hip fracture surgery may not be significant in terms of mortality and rate of free walking. Additionally, their predictive role in free walking ability is also not significant in the both overall population and females. However, in all individuals and females, AC, CC, and BS have strong predictive ability for 6-month and 1-year mortality.] Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0303067.r006
19 Apr 2024 Decision Letter - Amir Human Hoveidaei, Editor Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery. PONE-D-23-24968R3 Dear Dr. Chu, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Amir Human Hoveidaei, MD, MSc Academic Editor PLOS ONE Additional Editor Comments (optional): Dear authors, Many thanks for your revisions. I reviewed the paper as well as one of our peer-reviewers. All the comments are addressed. I recommend acceptance. Best, Amir H Hoveidaei, MD, MSc 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 #4: All comments have been addressed Reviewer #5: 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 #4: Yes Reviewer #5: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: Yes Reviewer #5: 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 #4: Yes Reviewer #5: 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 #4: Yes Reviewer #5: 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 #4: Thank you very much for revising the manuscript according to the comments. The manuscript's quality has improved after the revisions and I have no further comments. Reviewer #5: Dear authors, Many thanks for your submission. All the comments are addressed and paper reads well now. I recommend acceptance. ****** 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 #4: No Reviewer #5: No ******** https://doi.org/10.1371/journal.pone.0303067.r007
Formally Accepted
30 Apr 2024 Acceptance Letter - Amir Human Hoveidaei, Editor PONE-D-23-24968R3 PLOS ONE Dear Dr. Chu, 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. Amir Human Hoveidaei Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303067.r008

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