Predictors of in-hospital mortality among cirrhotic patients in Ethiopia: A multicenter retrospective study

Tamrat Petros Elias; Abate Bane Shewaye; Henok Fisseha; Abdulsemed Mohammed Nur; Kaleb Assefa Berhane; Asteray Tsige Minyilshewa; Kibrab Bulto Kumsa; Biruck Mohammed Seid

doi:10.1371/journal.pone.0322532

Peer Review History

Original SubmissionOctober 21, 2024
21 Oct 2024 Author Response https://doi.org/10.1371/journal.pone.0322532.r001
3 Jan 2025 Decision Letter - Alessandro Granito, Editor PONE-D-24-44329Predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia: A Multicenter Retrospective StudyPLOS ONE Dear Dr. Elias, 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 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, Alessandro Granito Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 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 [Note: HTML markup is below. 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 Reviewer #4: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: 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 Reviewer #4: 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: No Reviewer #4: 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 to determine predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia, a developing country. The manuscript is well written There are few issues the authors have to addressed 1. This could be because of the high viral hepatitis burden (second paragraph the reason for younger age of diagnosing liver cirrhosis..................... not only high burden but early age of acquisition of these viruses 2. The higher prevalence of liver cirrhosis and its complications in men is likely due to a combination of behavioral factors such as alcohol consumption, and biological factors such as lower levels of estrogen, which have been shown to have anti-fibrotic and anti-inflammatory effects on the liver that collectively increase their susceptibility to the development and progression of various liver diseases leading to cirrhosis ...................... this sentence is too long and therefore not clear 3. Kindly compare and contrast the percentage of ascites recorded in your study in the discussion section 4. Am not seeing authors contribution in the manuscript 5. Kindly check and rectify some of the reference Reviewer #2: Thank you, dear authors, for this interesting manuscript. Here are my comments: #Introduction: At the end of the introduction, please explicitly state that this manuscript has been reported in accordance with the STROBE guidelines. Cite the relevant reference and include the checklist at the end of the manuscript. #Kindly provide the reference for the diagnostic criteria of cirrhosis mentioned in the study #The manuscript requires minor grammatical corrections throughout to enhance clarity and readability. Reviewer #3: Cirrhosis is a common disease, and as a multicenter study, 299 cases is not a lot actually. There have been many previous studies on the etiology, but the correlation analysis of related factors for death in patients with liver cirrhosis in Ethiopia is relatively few, so it has certain novelty and clinical value. This study calls attention to certain risk factors and take earlier prevention measures. However, there are many defects in the manuscript that need to be modified: 1.Professional language polishing is needed. There are too many inappropriate spellings (including the Abstract) in the whole article, such as the first letter of many words in the sentence should be lowercase; abbreviations and full names of terms cross over and over again in the article; incorrect use of symbols. 2.In the paragraph 3 of Introduction, autoimmune liver disease should be also an important cause. 3. In the Methodology, the diagnostic criteria for the compensatory and decompensated stage of cirrhosis are quite different and should be distinguished. 4. The Child-Pugh and MELD Na scoring criteria need to be briefly mentioned in the Methodology. 5. The abbreviations of the terms in the Table need to be annotated. 6. What does COR refer to in Table2? 7. More discussion of hepatic encephalopathy is recommended. 8. Measures to prevent risk factors for death might be appropriately mentioned in the Discussion. Reviewer #4: Section Operational definition 1. Line 124: Liver cirrhosis: was diagnosed based on the presence of two or more of the following It would be more appropriate to write Liver cirrhosis was diagnosed based on the presence of two or more of the following : 2. Section Conclusion Do you think that a study carried out in 3 hospitals out of several others is enough to conclude about the whole country? ****** 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: Yes: Dr. Amoako Duah Reviewer #2: No Reviewer #3: No Reviewer #4: 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. Attachments Attachment Submitted filename: Reviewer comments.docx https://doi.org/10.1371/journal.pone.0322532.r002
Revision 1
12 Feb 2025 Author Response PONE-D-24-44329 Predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia: A Multicenter Retrospective Study Dear Editor and Reviewers; I hope this letter finds you well. I would like to express my gratitude for taking the time to review our manuscript. Your constructive feedback and comments have been invaluable in improving the quality and clarity of our work. I would like to address the concerns and comments raised in your review. I have carefully considered each one of them and have made the necessary changes to the manuscript accordingly. So please find the following comments and responses. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. - I have revised the manuscript according to PLOS ONE’s style requirements. 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 Reviewer #4: Partly ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: 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 Reviewer #4: 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: No Reviewer #4: Yes - Thank you for the positive response. Some sections of the manuscript are now edited to make it clearer. ________________________________________ 5. Review Comments to the Author Reviewer #1: This is to determine predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia, a developing country. The manuscript is well written - Thank you for the positive response. There are few issues the authors have to address 1. This could be because of the high viral hepatitis burden (second paragraph the reason for younger age of diagnosing liver cirrhosis..................... not only high burden but early age of acquisition of these viruses - Thanks for the insight. It is now included in the manuscript. 2. The higher prevalence of liver cirrhosis and its complications in men is likely due to a combination of behavioral factors such as alcohol consumption, and biological factors such as lower levels of estrogen, which have been shown to have anti-fibrotic and anti-inflammatory effects on the liver that collectively increase their susceptibility to the development and progression of various liver diseases leading to cirrhosis ...................... this sentence is too long and therefore not clear - The sentence is now rewritten in a clear & concise manner. 3. Kindly compare and contrast the percentage of ascites recorded in your study in the discussion section - The comparison of the prevalence of ascites in our study population with previous studies is now incorporated in the manuscript. 4. Am not seeing authors contribution in the manuscript - Sorry for that. Authors contribution is now included in the revised manuscript. 5. Kindly check and rectify some of the reference - Thanks for the feedback. The reference section is now edited. Reviewer #2: Thank you, dear authors, for this interesting manuscript. - Thank you for taking your time to review our manuscript. Here are my comments: #Introduction: At the end of the introduction, please explicitly state that this manuscript has been reported in accordance with the STROBE guidelines. Cite the relevant reference and include the checklist at the end of the manuscript. - Statement of Reporting Compliance with the STROBE guidelines along with the reference is included at the end of the introduction. The checklist is also included with manuscript submission as a supplementary material. #Kindly provide the reference for the diagnostic criteria of cirrhosis mentioned in the study - The reference for the diagnostic criteria of cirrhosis used in the study is included in the revised manuscript. #The manuscript requires minor grammatical corrections throughout to enhance clarity and readability. - Thank you for the feedback. The manuscript is now edited for language usage, spelling, and grammar. Reviewer #3: Cirrhosis is a common disease, and as a multicenter study, 299 cases is not a lot actually. There have been many previous studies on the etiology, but the correlation analysis of related factors for death in patients with liver cirrhosis in Ethiopia is relatively few, so it has certain novelty and clinical value. This study calls attention to certain risk factors and take earlier prevention measures. - Thank you for the positive response. However, there are many defects in the manuscript that need to be modified: 1.Professional language polishing is needed. There are too many inappropriate spellings (including the Abstract) in the whole article, such as the first letter of many words in the sentence should be lowercase; abbreviations and full names of terms cross over and over again in the article; incorrect use of symbols. - The manuscript is now edited for language usage, spelling, and grammar. 2.In the paragraph 3 of Introduction, autoimmune liver disease should be also an important cause. - Thank you for the reminder. Autoimmune hepatitis is now included as one of the major causes of liver disease. 3. In the Methodology, the diagnostic criteria for the compensatory and decompensated stage of cirrhosis are quite different and should be distinguished. - We totally agree with the reviewer's comment and have included information about liver decompensation in the second paragraph of the introduction. The reason we didn’t include it in the methodology section is because the current study included all patients with cirrhosis despite their compensation status. 4. The Child-Pugh and MELD Na scoring criteria need to be briefly mentioned in the Methodology. - The Child-Pugh and MELD Na scoring criteria are briefly discussed in the methodology (data collection tools and procedures) section of the revised manuscript. 5. The abbreviations of the terms in the Table need to be annotated. - Thank you for your suggestion. A list of abbreviations with their full forms has been added at the base of the table to enhance clarity and readability. 6. What does COR refer to in Table2? - COR in table 2 refers to crude odds ratio. Now, the abbreviation with its full form is included at the base of the table. 7. More discussion of hepatic encephalopathy is recommended. - Thank you for the input. In the revised manuscript, discussion about the spectrum, prevalence, and classification of hepatic encephalopathy is included. 8. Measures to prevent risk factors for death might be appropriately mentioned in the Discussion. - Measures to prevent risk factors for in-hospital mortality has now been included in the discussion section of the revised manuscript. Reviewer #4: Section Operational definition 1. Line 124: Liver cirrhosis: was diagnosed based on the presence of two or more of the following It would be more appropriate to write Liver cirrhosis was diagnosed based on the presence of two or more of the following : - Thank you for the suggestion. Correction has been made accordingly. 2. Section Conclusion Do you think that a study carried out in 3 hospitals out of several others is enough to conclude about the whole country? - We acknowledge that including additional hospitals could enhance the generalizability of the findings, but the three hospitals included in the study are the largest referral centers in the country, which receive a high volume of patients with cirrhosis from various regions, and we believe the findings are representative of the broader national population. Attachments Attachment Submitted filename: Cirrhosis Response to reviewers.docx https://doi.org/10.1371/journal.pone.0322532.r003
12 Mar 2025 Decision Letter - Alessandro Granito, Editor PONE-D-24-44329R1Predictors of in-hospital mortality among cirrhotic patients in Ethiopia: A multicenter retrospective studyPLOS ONE Dear Dr. Elias, 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 Apr 26 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, Alessandro Granito 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. 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 Reviewer #3: (No Response) ******** 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 Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: 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 Reviewer #3: 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 Reviewer #3: 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: All my previous recommendations have been addressed. However, the first paragraph of the results section should be under the methods section, maybe at the sample size. the reasons should be giving for those not meeting the inclusion criteria. Reviewer #3: 1.Please highlight or red the modified areas, otherwise it will increase the difficulty of reviewing again. 2.Although the language is much better than before, there are still some minor flaws, such as Child-Pugh is sometimes capitalized and sometimes lowercase, Median Age in Years maybe “Median age in years”� 3.What COR is in Table 2 remains unexplained. 4. Please explain why cirrhosis cannot be distinguished and analyzed according to decompensated and decompensated periods? ****** 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: No Reviewer #3: 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. Attachments Attachment Submitted filename: Review comments.docx https://doi.org/10.1371/journal.pone.0322532.r004
Revision 2
19 Mar 2025 Author Response PONE-D-24-44329R1 Predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia: A Multicenter Retrospective Study Dear Editor and Reviewers; I hope this letter finds you well. I would like to express my gratitude for taking the time to review our manuscript. Your constructive feedback and comments have been invaluable in improving the quality and clarity of our work. I would like to address the concerns and comments raised in your review. I have carefully considered each one of them and have made the necessary changes to the manuscript accordingly. So please find the following comments and responses. 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. - I have reviewed the reference list and found it to be complete, and no retracted paper was cited. 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 Reviewer #3: (No Response) - Thank you for the positive response. ________________________________________ 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 Reviewer #3: Yes - Thank you for the positive response. ________________________________________ 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: Yes - Thank you for the positive response. ________________________________________ 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 Reviewer #3: Yes - Thank you for the positive response. ________________________________________ 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 Reviewer #3: Yes - Thank you for the positive response. ________________________________________ 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: All my previous recommendations have been addressed. However, the first paragraph of the results section should be under the methods section, maybe at the sample size. The reasons should be giving for those not meeting the inclusion criteria. - Thank you for the suggestion. The first part of the result section is now included in the sample size section of the methodology part, and the explanation for being excluded from the study are also explained. Reviewer #3: 1. Please highlight or red the modified areas, otherwise it will increase the difficulty of reviewing again. - I apologize for any trouble this may have caused. The marked-up copy of our manuscript that highlights changes made to the original version is uploaded as a separate file labeled 'Revised Manuscript with Track Changes,' and an unmarked version of our revised paper without tracked changes is uploaded as a separate file labeled 'Manuscript.'. 2. Although the language is much better than before, there are still some minor flaws, such as Child-Pugh is sometimes capitalized and sometimes lowercase, Median Age in Years maybe “Median age in years”� - Thank you for the feedback. The aforementioned capitalization mistakes are now corrected. 3. What COR is in Table 2 remains unexplained. - COR and AOR are now described as crude odds ratio and adjusted odds ratio at the bottom of the table. 4. Please explain why cirrhosis cannot be distinguished and analyzed according to decompensated and decompensated periods? - Thank you for raising the idea. Analyzing patients survival based on their compensation status is advisable. However, the vast majority of our patients were admitted due to upper GI bleeding, hepatic encephalopathy, or ascites which are the signs of hepatic decompensation. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0322532.r005
24 Mar 2025 Decision Letter - Alessandro Granito, Editor Predictors of in-hospital mortality among cirrhotic patients in Ethiopia: A multicenter retrospective study PONE-D-24-44329R2 Dear Dr. Elias, 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, Alessandro Granito 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 #1: All comments have been addressed Reviewer #3: 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 Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: 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 Reviewer #3: 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 Reviewer #3: 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: The authors have addressed all my previous concerns. I have no other comments for the authors to address. Reviewer #3: (No Response) ****** 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: No Reviewer #3: No ******** https://doi.org/10.1371/journal.pone.0322532.r006
Formally Accepted
Acceptance Letter - Alessandro Granito, Editor PONE-D-24-44329R2 PLOS ONE Dear Dr. Elias, 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. Alessandro Granito Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0322532.r007

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .