Use peripheral blood leukocyte parameters combined with inflammatory indicators in diagnosis and severity assessment of mycoplasma pneumoniae pneumonia in children

Yuwen Zhang; Yuanpeng Zhai; Shuai Qi; Dan Huang; Jingjing Wang; Linyan Wang; Xuemei Dong; Zhipeng Sun; Jiaojiao Yin; Chong Zhang; Weikai Wang

doi:10.1371/journal.pone.0321454

Peer Review History

Original SubmissionJune 13, 2024
13 Jun 2024 Author Response Attachments Attachment Submitted filename: Response to Reviewers 2024.6.13.docx https://doi.org/10.1371/journal.pone.0321454.r001
9 Aug 2024 Decision Letter - Jennifer Tucker, Editor PONE-D-24-19765Use peripheral blood leukocyte parameters combined with inflammatory indicators in diagnosis and severity assessment of mycoplasma pneumoniae pneumonia in childrenPLOS ONE Dear Dr. Zhang, 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 note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. Please be aware that the editor who handles your revised manuscript might find it necessary to invite additional reviewers to assess this work once the revised manuscript is submitted. 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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: No ****** 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: The paper presents valuable findings on the use of leukocyte parameters and inflammatory markers to diagnose and assess the severity of MPP in children, but the authors need to address some shortcomings to enhance scientific rigor: 1 How was bacterial pneumonia diagnosed in this study, and which bacterial pathogens were included? 2 Mild MPP is self-limiting, and the diagnostic criteria for severe pneumonia also include disease duration factors. 3 Did the authors consider disease duration factors in the study design, and how did they avoid the influence of disease duration on the study results? 4 The discussion should explain and discuss the significance of leukocyte parameters. 5 The manuscript does not provide sufficient information on whether and how the assumptions for each statistical test were checked. This includes assumptions for normality, homogeneity of variances, and independence. 6 The use of multiple logistic regression models without a clear justification for the selection of variables could lead to overfitting, especially given the relatively small sample size in some groups. ****** 6. 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: 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.0321454.r002
Revision 1
25 Sep 2024 Author Response 1.How was bacterial pneumonia diagnosed in this study, and which bacterial pathogens were included? The diagnosis of bacterial pneumonia is made by clinicians combining clinical examination with imaging studies to diagnose pneumonia, followed by multiple PCR pathogen detection to rule out mixed infections of viral and bacterial pneumonia, leading to the diagnosis of bacterial pneumonia Among them, the detection rate of Haemophilus influenae was the highest, 52.5% (27/52), followed by Staphylococcus aureus 27.1% (15/52), Streptococcus pyogenes 9.6% (5/52), Escherichia coli 5.8% (3/52) and Klebsiella pneumoniae 3.8% (2/52). 2.Mild MPP is self-limiting, and the diagnostic criteria for severe pneumonia also include disease duration factors. Regarding the diagnostic criteria for MPP, we reviewed relevant literature The course of mild MPP is generally 7-10 days, while there is no consensus on the course of severe MPP. We found the following about the fever duration in severe MPP: persistent high fever (≥39°C) for ≥5 days or fever for ≥7 days without a decline in peak temperature. 3.Did the authors consider disease duration factors in the study design, and how did they avoid the influence of disease duration on the study results? Regarding the comparison between MPP and bacterial pneumonia, there was no statistically significant difference in the disease duration between the two groups (P>0.05). However, there was a statistically significant difference in the disease duration between the two groups of mild MPP and severe MPP (P<0.05). We did not consider the disease duration of illness because the disease duration is related to the severity of the disease, and the abnormal diagnostic indicators is also related to the severity of the disease. However, the disease duration may not be directly related to the diagnostic indicators. Furthermore, the severity of the disease determines the disease duration. The disease duration is not a factor that leads to the severity of the disease, so we did not consider the disease duration. 4.The discussion should explain and discuss the significance of leukocyte parameters. We added the significance of leukocyte parameters in the Introduction and Discussion section. 5.The manuscript does not provide sufficient information on whether and how the assumptions for each statistical test were checked. This includes assumptions for normality, homogeneity of variances, and independence 6.The use of multiple logistic regression models without a clear justification for the selection of variables could lead to overfitting, especially given the relatively small sample size in some groups. We have supplemented the descriptions related to normality,etc. In this research, statistical approaches were initially employed to determine whether the data conformed to the criteria of normal distribution. The t-test was utilized for quantitative data that adhered to the criteria for normal distribution, whereas the Mann-Whitney U test was applied for non-normal quantitative data. The Pearson's Chi-squared Test was employed for categorical variables. Quantitative data that met the criteria for normal distribution was presented as the mean ± standard deviation (SD), while non-normal distribution data was represented as the median (interquartile range [IQR]). p-value < 0.05 was regarded as statistically significant. Subsequently, univariate binary Logistic regression analysis was executed, and variables that demonstrated a univariate binary relationship were input into the Multifactorial binary logistic regression, p-value<0.05 was considered statistically significant. Given the number of available events,variables of leukocyte parameters and inflammatory indicators for inclusion were carefully chosen and separately input into the multifactorial binary logistic regression analysis for statistics to avoid overfitting. Finally, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were plotted to assess the diagnostic efficacy of the white blood cell parameters, p-value <0.05 is considered statistically significant. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0321454.r003
3 Jan 2025 Decision Letter - Senthilnathan Palaniyandi, Editor <div>PONE-D-24-19765R1Use peripheral blood leukocyte parameters combined with inflammatory indicators in diagnosis and severity assessment of mycoplasma pneumoniae pneumonia in children外周血白细胞参数结合炎症指标对儿童肺炎的诊断和严重程度评价PLOS ONE Dear Dr. Zhang, 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 have received the expert reviewer's opinions and invite you to submit a revised version of the manuscript. Please consider and address each of the comments raised by the reviewers. Please submit your revised manuscript by Feb 17 2025 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, Senthilnathan Palaniyandi, Ph.D Academic Editor PLOS ONE Journal Requirements: 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. 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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: 1 A large number of leukocyte parameters (e.g., NE-WY, MO-WX) are presented in the results, but the clinical significance of each is not discussed thoroughly.I suggest the authors focus on the most clinically significant parameters. They should discuss in detail how these specific parameters aid in diagnosing MPP or assessing its severity. For example, they should explain why certain parameters, such as MO-WZ, are more predictive of severe MPP than others. 2 The paper appears to conduct multiple comparisons (e.g., comparisons of various leukocyte parameters and inflammatory markers), but there is no mention of adjustments for multiple testing, such as the Bonferroni correction or False Discovery Rate (FDR) control.I recommend applying correction methods to control the increased risk of Type I errors (false positives) when conducting multiple comparisons. The corrected p-values should be clearly indicated in the table, or the authors should explain the reasons for not making corrections. ****** 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: Xu Yongsheng ******** [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.0321454.r004
Revision 2
25 Jan 2025 Author Response 1. A large number of leukocyte parameters (e.g., NE-WY, MO-WX) are presented in the results, but the clinical significance of each is not discussed thoroughly.I suggest the authors focus on the most clinically significant parameters. They should discuss in detail how these specific parameters aid in diagnosing MPP or assessing its severity. For example, they should explain why certain parameters, such as MO-WZ, are more predictive of severe MPP than others. We have discussed the clinical significance of partially supplemented leucocyte parameters (e.g., NE-WY, MO-WX, etc.) and have highlighted them in red. 2.The paper appears to conduct multiple comparisons (e.g., comparisons of various leukocyte parameters and inflammatory markers), but there is no mention of adjustments for multiple testing, such as the Bonferroni correction or False Discovery Rate (FDR) control.I recommend applying correction methods to control the increased risk of Type I errors (false positives) when conducting multiple comparisons. The corrected p-values should be clearly indicated in the table, or the authors should explain the reasons for not making corrections. We adjusted the statistical methods as follows: Kolmogorov-Smirnov test was used to test the normality of each index. ANOVA test was used for normally distributed quantitative data, the Mann-Whitney U test was used for non-normally distributed quantitative data between the two groups, the Kruskal-Wallis test was used for non-normally distributed quantitative data between the multiple groups.After the overall significant difference between multiple groups was compared, Bonferroni correction test was used, and p-value < 0.05 after adjusting the significance was considered to be statistically significant. Attachments Attachment Submitted filename: Response to Reviewers1.25.docx https://doi.org/10.1371/journal.pone.0321454.r005
7 Mar 2025 Decision Letter - Senthilnathan Palaniyandi, Editor <p>Use peripheral blood leukocyte parameters combined with inflammatory indicators in diagnosis and severity assessment of mycoplasma pneumoniae pneumonia in children外周血白细胞参数结合炎症指标对儿童肺炎的诊断和严重程度评价 PONE-D-24-19765R2 Dear Dr. Zhang, 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, Senthilnathan Palaniyandi, Ph.D Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0321454.r006
Formally Accepted
Acceptance Letter - Senthilnathan Palaniyandi, Editor PONE-D-24-19765R2 PLOS ONE Dear Dr. Zhang, 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. Senthilnathan Palaniyandi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0321454.r007

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