Identification of risk factors and establishment of prediction models for mortality risk in patients with acute kidney injury: A retrospective cohort study

Shengtao Li; Zhanzhan Li; Yanyan Li

doi:10.1371/journal.pone.0312482

Peer Review History

Original SubmissionJune 21, 2024
3 Sep 2024 Decision Letter - Vipa Thanachartwet, Editor PONE-D-24-24695Identification of risk factors and establishment of prediction models for mortality risk in patients with acute kidney injury: A retrospective cohort studyPLOS ONE Dear Dr. Li, 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. We appreciate your study which is an interesting study. However, there are some points raised by the reviewer and need to be clarified. Please carefully respond to the reviewer comments and suggestions. Please submit your revised manuscript by Oct 18 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. 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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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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: This is a single retrospective study try to explore 2 focal targets as following 1. Demonstrating independent factors influencing the 90 day and 1 year mortality in patients with Acute Kidney Injury (AKI) among 1079 non surgical related AKI patients admitted to Changsha First Hospital, China during June 2018 and May 2020. 2. Developed and validate models to predict the above patient mortality risk. My comments and concerns: 1. Feng et al. In JAMA Network Open 2023;6:e2313359, has presented an article entitled “ Characterization of Risk Prediction Models for Acute Kidney Injury: A Systematic Review and Meta-analysis”. In addition, Feng developed a prediction model for AKI using a statistical model included 150 studies from literature search containing 14.4 million participants. Moreover, well known epidemiological data regarding AKI which have been reported elsewhere in current textbook and current literatures ((UptoDate 2024, Liangos et al in “Kidney and patient outcomes after acute kidney injury in adults”). So this is not an original one to report the results related to the purpose of the manuscript. In addition, this manuscript report restrospective data from a single center with subjects of 1079 patients which is much smaller comparing to the JAMA report. 2. The authors develop a model to generate a mortality risk prediction model and validate the model utilize the 5-fold cross validation technique. However, it is not cleared about how the normogram in Figure 3 are derived from. 3. The authors in this manuscript conclude age ≥ 60 years, anemia, symptoms of hypotension, organ failure, admission Scr level ≥ 682.3 micromoles/L, organ failure, and mechanical ventilation are independent factors associated with 90-day or one-year mortality in AKI and the Logistic regression model constructed based on these factors can effectively predict the 90-day and one-year mortality risk for AKI patients. In addition they conclude their study will provides theoretical reference for clinical risk management. It has been known that factors influencing mortality have been described elsewhere (UptoDate 2024, Liangos et al in “Kidney and patient outcomes after acute kidney injury in adults”). In the mentioned review, Liangos report odd ratio of the factors influencing mortality. In various AKI reports have mention additional factors such as post surgery, underlying cardiovascular or cerebrovascular events, APACHE scores criteria of the study. ****** 6. 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Revision 1
19 Sep 2024 Author Response Response to Editorial office When submitting your revision, we need you to address these additional requirements. Comment 1: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response 1: Yes, we have revied the format of manuscript according to these requirements. Comment 2: Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. Response 2: Yes, we have provided this. Comment 3: Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Response 3: Yes, we have revises this. Response to Reviewer #1: This is a single retrospective study try to explore 2 focal targets as following 1. Demonstrating independent factors influencing the 90 day and 1 year mortality in patients with Acute Kidney Injury (AKI) among 1079 non-surgical related AKI patients admitted to Changsha First Hospital, China during June 2018 and May 2020. 2. Developed and validate models to predict the above patient mortality risk. My comments and concerns: Comment 1: Feng et al. In JAMA Network Open 2023;6:e2313359, has presented an article entitled “ Characterization of Risk Prediction Models for Acute Kidney Injury: A Systematic Review and Meta-analysis”. In addition, Feng developed a prediction model for AKI using a statistical model included 150 studies from literature search containing 14.4 million participants. Moreover, well known epidemiological data regarding AKI which have been reported elsewhere in current textbook and current literatures ((UptoDate 2024, Liangos et al in “Kidney and patient outcomes after acute kidney injury in adults”). So, this is not an original one to report the results related to the purpose of the manuscript. In addition, this manuscript reports retrospective data from a single center with subjects’ of 1079 patients which is much smaller comparing to the JAMA report. Response 1: Thank you for your advice. We totally agree with you that some studies about this topic had been published. First, this study is totally different from ours. This study focusses one the occurrence of AKI, and our study is to evaluate the prognosis of AKI. Different study population in different region may have different results, even small differences. Plos one is a very inclusive journal, that the editors of Plos one makes decisions on submissions based on scientific rigor, That the editors of Plos one makes decisions on submissions based on scientific rigor, regardless of novelty. It is precisely because of this that we choose to contribute to this journal, which provides us with a good platform for publishing research, so that even small researchers like us can make their own voices. According to the statistical experience, the sample size should be is 10-20 times the number of factors studied, and the present study meet the requirements of sample size. Comment 2: The authors develop a model to generate a mortality risk prediction model and validate the model utilize the 5-fold cross validation technique. However, it is not cleared about how the nomogram in Figure 3 are derived from. Response 2: Thank you for your advice. The nomogram in Figure 3 was based on the training dataset. We performed the multivariate logistic regressions and only included these variables in the nomogram that were significant in the model. this is routing data analyses strategy. We have added some descriptions in the results. Comment 3: The authors in this manuscript conclude age ≥ 60 years, anemia, symptoms of hypotension, organ failure, admission Scr level ≥ 682.3 micromoles/L, organ failure, and mechanical ventilation are independent factors associated with 90-day or one-year mortality in AKI and the Logistic regression model constructed based on these factors can effectively predict the 90-day and one-year mortality risk for AKI patients. In addition, they conclude their study will provides theoretical reference for clinical risk management. It has been known that factors influencing mortality have been described elsewhere (UptoDate 2024, Liangos et al in “Kidney and patient outcomes after acute kidney injury in adults”). In the mentioned review, Liangos report odd ratio of the factors influencing mortality. In various AKI reports have mention additional factors such as post-surgery, underlying cardiovascular or cerebrovascular events, APACHE scores criteria of the study. Response 3: Thank you for your advice. We read the publication: Characterization of Risk Prediction Models for Acute Kidney Injury: A Systematic Review and Meta-analysis. You can see this study is a systematic review and meta-analysis, which to systematically review published AKI prediction models across all clinical sub settings. This study is totally different from ours. This study focusses one the occurrence of AKI, and our study is to evaluate the prognosis of AKI. The study outcomes is completely different. Though the sample size is very large, and it seems our study data is higher efficiency. Moreover, this study also indicated that the variation in the clinical settings, populations, and predictive variables are wide, which makes these study high statistical heterogeneity that could not be ascribed to any particular variable other than geographical region. This means study population in different regions may have different characteristics. Our study also contributed some results among these models. The UptoDate seems to need some fee that we can’t afford, which is difference between us and other higher-level hospital. You also mentioned that in various AKI reports have mention additional factors such as post-surgery, underlying cardiovascular or cerebrovascular events, APACHE scores criteria of the study. I think this may be due to different study population, clinical management way, treatment (different treatment may have different medical data), and hospital level. But anyway, the study could be appropriate when the data was applied in local region based on current situation. We also added some descriptions in discussion. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0312482.r002
8 Oct 2024 Decision Letter - Vipa Thanachartwet, Editor Identification of risk factors and establishment of prediction models for mortality risk in patients with acute kidney injury: A retrospective cohort study PONE-D-24-24695R1 Dear Dr. Li Yanyan, 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, Vipa Thanachartwet, M.D. Academic Editor PLOS ONE Additional Editor Comments (optional): All issues have been addressed. 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 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 ****** 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: None ****** 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: Thanom Supaporn MD. PhraMongkutklao Hospital and College of Medicine, Bangkok, Thailand ******** https://doi.org/10.1371/journal.pone.0312482.r003
Formally Accepted
11 Oct 2024 Acceptance Letter - Vipa Thanachartwet, Editor PONE-D-24-24695R1 PLOS ONE Dear Dr. Li, 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 Professor Vipa Thanachartwet Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0312482.r004

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