PONE-D-24-16126Systemic Immune Inflammation Index as a Predictor of Disease Severity in Tetanus Patients: A retrospective Observational StudyPLOS ONE

Dear Dr. HUANG,

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.

What was the total number of tetanus patients seen in the hospital during the study period, and what was the number of those that were excluded due to insufficient data, those excluded on the ground that they were discharged within 24 hours of admission, and those excluded because they were below the study adult age range.

The study was conducted in adults; however, the age range of adults was not stated. This should be part of the inclusion criteria.

The study's retrospective design, which limits control over selection bias and missing data, should be considered a drawback in addition to those mentioned in the discussion section. The recommendation for a much larger study is in order; however, this preferably should be a prospective study.

The references need to be reviewed; most do not conform to PLOS One reference guideline (https://journals.plos.org/plosone/s/submission-guidelines). Furthermore, I could not find references 6, 15 and 16 from literature search.

A majority of the References were more than five years; ideally, at least 60-70% of the References should be less than 5 years post publication. This must be addressed.

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We look forward to receiving your revised manuscript.

Kind regards,

Innocent Ijezie Chukwuonye, MBBS, FMCP(Internal Medicine)

Academic Editor

PLOS ONE

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2. In the online submission form, you indicated that The data underlying the results presented in the study are available from corresponding author: Huang Jizheng, hjzh_ly@126.com

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Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: I would like to thank the author(s) for the contribution and their manuscript. I have to highlight few comments to further improve this manuscript.

1- There are few scattered spelling mistakes like the word "conformed" in Page 9 and the word "tracheotomy" in Page 18.

2- The author highlighted that the total sample size was 34. However, what was the sample size before the exclusion criteria, in other words, how many patients were admitted with tetanus?

3- The method section seems a bit confusing and not reproducible. The author stated that the patients were categorised into ICU and non-ICU group. The word "categorised" seems inappropriate in this context as patients were not randomised. [This categorisation introduces bias]

4- The author need to illustrate when was the SII calculated. Was it calculated upon admission? Also, is there a role of monitoring serial or daily SII to predict progression of severity and/or morbidity?

5- Was the treatment similar to both arms of the study (the ICU and non-ICU groups)?

6- The discussion section highlights the importance of timely management. However, it does not answer the topic clearly which is the role of SII as this is the cornerstone of this manuscript and their is lack of literature review.

Reviewer #2: You should follow journal guide.

Unistyle references.

Add more figure to clarify your work.

Well done.

You should follow journal guide.

Unistyle references.

Add more figure to clarify your work.

Well done.

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Reviewer #1: No

Reviewer #2: Yes: Yahya Ali Abdulkareem Abodea

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Attachments

Attachment

Submitted filename: tetanus manuscript..doc

Systemic Immune Inflammation Index as a Predictor of Disease Severity in Tetanus Patients: A retrospective Observational Study

PONE-D-24-16126R1

Dear Dr. Huang Jizheng

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.

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Kind regards,

Innocent Ijezie Chukwuonye, MBBS, FMCP(Internal Medicine)

Academic Editor

PLOS ONE

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