PONE-D-24-38419HALP score for predicting early and late mortality in elderly patients with proximal femur fracturesPLOS ONE

Dear Dr. Vural,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The research question and methodology sound good. I have a few comments.

1) From line 124-126, could you explain more why you used cutoff points of 17.975 for HALP, 28.145 for CRP, and 0.6574 for CAR to predict the mortality?

2) Could you please provide more details about “Comorbidity”

3) Could you please provide more details about proximal femoral fracture: how many femoral neck and intertrochanteric fracture in this cohort?

4) The pictures were not clear. Could you please improve the quality of the pictures.

Reviewer #2: Authors have targeted a very sound and important subject which should be commended. Overall, the manuscript is well-written and analysis is very good. There are some suggestions that might increase overall comprehension.

1. Please add full abbreviation of HALP in the title.

2. Line no. 81-83: Please clarify this line: "which occur mostly in the setting of osteoporosis, and the HALP score", what do you mean by occur mostly in the HALP score. Elaboration will be appreciated.

3. Line no.134: Write statistical analysis as the heading.

4. Line no.181: correct spelling: "predicting"

5. Line no.208: Make separate table for univariate binary logistic regression analysis

6. Line no.232-235: Mention reference for the study.

7. Line no.235-238: Mention reference for cancer studies

Reviewer #3: The study titled, “HALP score for predicting early and late mortality in elderly patients with proximal femur fractures” by Vural et al. presents some very interesting findings on the HALP score and how it can be used to predict mortality. However, to further improve the manuscript I would suggest the authors make the following edits:

• Pages 2-3, Introduction Section: The introduction requires further improvement to clearly explain the need for a scoring system like HALP. The authors should highlight the limitations of existing scoring systems for predicting mortality in elderly patients with PFFs and explain how the HALP score addresses these gaps. Emphasizing the potential benefits and advantages of the HALP score would strengthen the rationale for its use in this context. Currently, the rationale for the study is weak and needs to be more compelling to justify the focus on the HALP score.

• Pages 2-3, Introduction Section: While one of the objectives of this study is to compare CRP and CAR with the HALP score in predicting mortality endpoints, the rationale behind selecting these specific markers for comparison is unclear. I suggest the authors elaborate on this to strengthen the relevance and significance of their study.

• Pages 4-5, Methods Section: Did the authors adjust the results for any confounding variables? If so, please mention them in the methodology section. If not, it should be noted in the limitations section of the study.

• Pages 8-9, Discussion Section: The authors have provided a thorough discussion comparing the HALP score with other predictive biomarkers, emphasizing its efficacy in predicting mortality in older patients with PFF. However, I believe that a deeper exploration of the biological mechanisms underlying the HALP score's effectiveness in predicting mortality would enhance the manuscript. Specifically, discussing how the components of the HALP score (hemoglobin, albumin, lymphocyte count, and platelet count) are linked to mortality could provide valuable insights into the clinical implications of the findings.

• Page 2, Line 50: Please recheck the entire manuscript for any typographical errors, such as the incorrect spelling of the abbreviation "PPF" in the abstract. Additionally, ensure that there is enough spacing between the sections of the manuscript.

• Page 10, Lines 104-105: The authors should explicitly mention what "Karmed" refers to in the methods section, as its current usage can lead to potential ambiguity in readers' minds.

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Reviewer #1: No

Reviewer #2: Yes: Tabeer Tanwir Awan

Reviewer #3: No

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Hemoglobin, albumin, lymphocyte and platelet (HALP) score for predicting early and late mortality in elderly patients with proximal femur fractures

PONE-D-24-38419R1

Dear Dr. Vural,

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.

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Kind regards,

Raffaele Vitiello

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #2: (No Response)

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: (No Response)

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: (No Response)

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: (No Response)

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: (No Response)

Reviewer #3: Yes

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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 #2: (No Response)

Reviewer #3: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: Yes: Tabeer Tanwir Awan

Reviewer #3: No

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