Sepsis risk in diabetic patients with urinary tract infection

Sipei Wang; Sheng Zhao; Shanshan Jin; Tinghua Ye; Pan Xinling

doi:10.1371/journal.pone.0303557

Peer Review History

Original SubmissionJanuary 15, 2024
8 Feb 2024 Decision Letter - Seth Agyei Domfeh, Editor PONE-D-23-44217Sepsis risk in diabetic patients with urinary tract infectionPLOS ONE Dear Dr. Xinling, 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 Mar 24 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. 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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 Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: 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 Reviewer #3: 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 Reviewer #3: 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: General impression: The research paper provides a concise overview of the study conducted on diabetic individuals with urinary tract infections (UTIs) and their risk of developing sepsis. The article effectively communicates the research objectives, methodology, key findings, and conclusions of the study in a clear and concise manner. The investigation was carried out to a very high technical standard, as evidenced by the article's thorough explanations of the procedures employed for specimen processing, data collecting, and statistical analysis. Making these points clear improves the findings' repeatability and dependability. The statistical techniques applied, such as the usage of SPSS software and different tests including logistic regression, t-test, and Chi-square, are suitable for the analysis of the data. The explanation of the treatment of continuous variables according to their distribution clarifies the analysis procedure. As is customary with categorical data, the article discusses the display of counting data in cases and percentages. When dealing with non-normally distributed data, the usage of medians and quartiles is appropriate. It is laudable that a multivariate logistic regression model with a forward selection strategy was included in order to find important factors related to the desired outcomes. A reliable technique for assessing prediction models is the application of ROC curve analysis to determine the discriminatory strength of the selected variables. The statistical analysis performed for the study lends support to the appropriateness of the conclusions derived from the data. Minor issues 1. It is imperative to state the study's limitations, including the possibility of biases present in retrospective studies and the applicability of the findings to larger patient populations. 2. The study runs from January 2011 to June 2022, or more than ten years. If the analysis does not sufficiently address or account for changes in clinical practices, diagnostic criteria, or treatment procedures over time, temporal bias may be introduced. Authors should kindly state whether any notable modifications to the treatment of sepsis, UTIs, or diabetes occurred throughout the study period that would have affected the results found. Reviewer #2: The article written by Wang et al. analysed the evolution of sepsis for diabetic patients with urinary tract infections. The title and the abstract are appropriate for the content of the text.Furthermore, the article is well constructed and analysis was well performed.Even if the statistics is very simple, the results obtained are very clear and demonstrate a relation between sepsis and biochemical parameters. The article highlights important data related to CRP, WBC and ALB which can be used to detect sepsis from early stages. Reviewer #3: Peer Review Report Manuscript #: PONE-D-23-44217 Peer Review Report on “Sepsis risk in diabetic patients with urinary tract infection” 1. Original submission 1.1 Recommendation Minor revision 2. Comments to Authors This study was performed to analyze the risk variables associated with sepsis in diabetes individuals with urinary tract infection (UTI) in China. The manuscript is fairly written but the authors need to make some minor revision to the manuscript in order to improve the manuscript significantly. Below are details of my concerns and I ask that the authors specifically address each of my concern or comments in their response. Line 65: change is after objective to was Line 72: change was before retrospectively to were Line 77: replace the full stop after nmol/L with comma Line 81: replace the full stop after ≥105 mL with comma Line 83: replace full stop after same with comma Line 84: replace full stop after culture with comma Lines 84 to 86: consider revising the sentence beginning typical symptoms of UTI…….. as it not clear. Also early morning cleaning in the sentence should read early morning clean, gram should be written as Gram Line 97: write CO2 as CO2 Line 101: change include to included; you either write Stap in full or use S. saprophyticus Line 128: change involves to involved Provide appropriate heading for Table 1, for example Table 1…………………….the table heading should be placed on top of the Table Line 165: write table with initial upper-case letter Line 175: The Table 2 heading is not appropriate so change it. It could be written as Table 2: Risk factors for sepsis in diabetic patients Line 191: write enterococcus with initial upper-case letter 199: italicize Staphylococcus aureus Line 221: change with to ‘to’ Line 229: change leads to lead Line 246: change Supplementary table 2 to Supplementary Table 2 Line 248: change Supplementary fig 1 to Supplementary Fig 1 Line 249: change table to Table Properly label the Table on page 11 with proper heading Line 252: change fig to Fig Page 23: italicize all the scientific names of bacteria besides the pie chart ******** https://doi.org/10.1371/journal.pone.0303557.r001
Revision 1
25 Apr 2024 Author Response Reviewer #1: General impression: The research paper provides a concise overview of the study conducted on diabetic individuals with urinary tract infections (UTIs) and their risk of developing sepsis. The article effectively communicates the research objectives, methodology, key findings, and conclusions of the study in a clear and concise manner. The investigation was carried out to a very high technical standard, as evidenced by the article's thorough explanations of the procedures employed for specimen processing, data collecting, and statistical analysis. Making these points clear improves the findings' repeatability and dependability. The statistical techniques applied, such as the usage of SPSS software and different tests including logistic regression, t-test, and Chi-square, are suitable for the analysis of the data. The explanation of the treatment of continuous variables according to their distribution clarifies the analysis procedure. As is customary with categorical data, the article discusses the display of counting data in cases and percentages. When dealing with non-normally distributed data, the usage of medians and quartiles is appropriate. It is laudable that a multivariate logistic regression model with a forward selection strategy was included in order to find important factors related to the desired outcomes. A reliable technique for assessing prediction models is the application of ROC curve analysis to determine the discriminatory strength of the selected variables. The statistical analysis performed for the study lends support to the appropriateness of the conclusions derived from the data. Authors’ response: Thanks for positive comment from the reviewer. Minor issues 1. It is imperative to state the study's limitations, including the possibility of biases present in retrospective studies and the applicability of the findings to larger patient populations. Authors’ response: We agreed to the reviewer’s comment that there were some limitations in this study, including the bias in retrospective studies and possible reduced applicability of the findings in other patient population. Thus, the limitations of this study were described in the revised manuscript. 2. The study runs from January 2011 to June 2022, or more than ten years. If the analysis does not sufficiently address or account for changes in clinical practices, diagnostic criteria, or treatment procedures over time, temporal bias may be introduced. Authors should kindly state whether any notable modifications to the treatment of sepsis, UTIs, or diabetes occurred throughout the study period that would have affected the results found. Authors’ response: Thanks for constructive comments. As the reviewer mentioned above, the clinical guidelines for diagnosis and treatment were reviewed to analyze the bias in this study. The diagnosis for sepsis was modified based on the sepsis 3.0, which was proposed in 2016. Thus, the data collected from 2011 to 2016 owned a significantly lower incidence of sepsis than that from 2017 to 2022. Another reason for the increasing incidence of sepsis was the stricter criteria for hospitalization, resulting into the fact that the patients who were accompanied by mild symptoms or less likely developed into worse status could not be hospitalized. However, the same analysis procedure was adopted in these two data (the groups admitted before and after 2016, respectively) and found that WBC, ALB and CRP were the consistent risk factors for sepsis. Therefore, the existence of bias from modification of sepsis diagnosis criteria did not change the risk factors enrolled in final prediction model. For the guidelines for UTI, there is nearly no modification. The diagnosis criteria for diabetes was modified in 2020, and adopted in clinical practice in 2021. The data from 2021 to 2022 accounted for 8% of total cases, limiting its influence on the findings. In conclusion, the bias in guidelines may have impact on the incidence of diseases, but had limited role in the risk factors related to sepsis risk in diabetic patients with UTI. The corresponding description was added in the limitation section. Reviewer #2: The article written by Wang et al. analysed the evolution of sepsis for diabetic patients with urinary tract infections. The title and the abstract are appropriate for the content of the text. Furthermore, the article is well constructed and analysis was well performed. Even if the statistics is very simple, the results obtained are very clear and demonstrate a relation between sepsis and biochemical parameters. The article highlights important data related to CRP, WBC and ALB which can be used to detect sepsis from early stages. Authors’ response: Thanks for kind comments from the reviewer, and we believe our findings could be helpful for clinical staffs to evaluate the risk of sepsis in diabetic patients with urinary infection. Reviewer #3: Peer Review Report Manuscript #: PONE-D-23-44217 Peer Review Report on “Sepsis risk in diabetic patients with urinary tract infection” 1. Original submission 1.1 Recommendation Minor revision 2. Comments to Authors This study was performed to analyze the risk variables associated with sepsis in diabetes individuals with urinary tract infection (UTI) in China. The manuscript is fairly written but the authors need to make some minor revision to the manuscript in order to improve the manuscript significantly. Below are details of my concerns and I ask that the authors specifically address each of my concern or comments in their response. Line 65: change is after objective to was Line 72: change was before retrospectively to were Line 77: replace the full stop after nmol/L with comma Line 81: replace the full stop after ≥105 mL with comma Line 83: replace full stop after same with comma Line 84: replace full stop after culture with comma Lines 84 to 86: consider revising the sentence beginning typical symptoms of UTI…….. as it not clear. Also early morning cleaning in the sentence should read early morning clean, gram should be written as Gram Line 97: write CO2 as CO2 Line 101: change include to included; you either write Stap in full or use S. saprophyticus Line 128: change involves to involved Provide appropriate heading for Table 1, for example Table 1…………………….the table heading should be placed on top of the Table Line 165: write table with initial upper-case letter Line 175: The Table 2 heading is not appropriate so change it. It could be written as Table 2: Risk factors for sepsis in diabetic patients Line 191: write enterococcus with initial upper-case letter 199: italicize Staphylococcus aureus Line 221: change with to ‘to’ Line 229: change leads to lead Line 246: change Supplementary table 2 to Supplementary Table 2 Line 248: change Supplementary fig 1 to Supplementary Fig 1 Line 249: change table to Table Properly label the Table on page 11 with proper heading Line 252: change fig to Fig Page 23: italicize all the scientific names of bacteria besides the pie chart Authors’ response: Thanks for detailed comments on our manuscript. We have checked the comments and modified them in revised text point by point. It was kind of the reviewer giving us helpful comments. Thanks again. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0303557.r002
29 Apr 2024 Decision Letter - Seth Agyei Domfeh, Editor Sepsis risk in diabetic patients with urinary tract infection PONE-D-23-44217R1 Dear Dr. Xinling, 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, Seth Agyei Domfeh, PhD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303557.r003
Formally Accepted
4 May 2024 Acceptance Letter - Seth Agyei Domfeh, Editor PONE-D-23-44217R1 PLOS ONE Dear Dr. Xinling, 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. Seth Agyei Domfeh Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303557.r004

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