Clinical & laboratory profiles and treatment outcome of Kawasaki disease in children: Experience from a tertiary care hospital

Shareen Khan; Md Abid Hossain Mollah; Abdul Baki; Nabila Tabassum; Nasreen Islam; Amrita Lal Halder; Tasnima Ahmed; Nurun Nahar Fatema; Jebun Nahar; Fauzia Mohsin; Mohammod Jobayer Chisti

doi:10.1371/journal.pone.0328443

Peer Review History

Original SubmissionJanuary 4, 2025
12 May 2025 Decision Letter - Jyoti Sharma, Editor -->PONE-D-24-55276-->-->Clinical & laboratory profiles and treatment outcome of Kawasaki Disease in children: Experience from a tertiary care hospital-->-->PLOS ONE Dear Dr. Chisti, 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 Jun 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. 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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. [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: Partly Reviewer #2: Yes ******** -->2. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: No Reviewer #2: 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 ****** -->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 ****** -->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 manuscript examines Kawasaki Disease in children at a Bangladeshi tertiary care hospital, providing valuable data through detailed clinical and laboratory profiles of 40 cases. While the study's strengths include clear documentation of treatment outcomes, several concerns need addressing - notably the unusually high rates of incomplete KD and coronary abnormalities, statistical rigor, methodology clarity, and limited discussion of findings in context of current literature. With appropriate revisions, this work could meaningfully contribute to understanding KD in Bangladesh. Major Comments: 1. While several laboratory tests were performed (CBC, ESR, CRP, SGPT, S. creatinine, blood C/S, Urine R/ME, C/S), the Results section only presents and analyzes a limited subset of these findings, primarily focusing on CRP, ESR, and CBC parameters. The data from other tests like SGPT, creatinine, blood culture, and urinalysis are mentioned in Methods but not reported or analyzed in the Results. To maintain scientific rigor and completeness, either all laboratory data should be presented and analyzed to justify the term "laboratory profiles" in the title, or the title should be modified to reflect the actual scope of reported findings. 2. Your introduction requires updating with literature from 2022-2024 to better contextualize your findings within current Kawasaki Disease research. We recommend incorporating recent epidemiological data (especially from South Asia), modern diagnostic approaches, and contemporary treatment outcomes. While retaining seminal papers, please replace pre-2015 references with current evidence on regional epidemiology, diagnostic criteria, and treatment guidelines to strengthen your manuscript's relevance and contribution to the field. 3. Clarify diagnostic criteria used for incomplete KD. 4. The statistical methodology requires significant revision. While P-values are presented, the specific statistical tests used are not specified, and there is no sample size calculation or power analysis. The authors should clearly state which statistical tests were employed and provide justification for the sample size to ensure scientific validity. 5. Add multivariate analysis of risk factors for coronary involvement. 6. Figure 1 is overly simple - additional figures showing key findings would be valuable. 7. The Discussion section needs substantial revision as it currently focuses too heavily on restating results rather than interpretation and context. We recommend reducing the descriptive content of findings and expanding the analytical discussion, particularly comparing your results with contemporary literature and explaining the high rates of incomplete KD and coronary involvement observed in your study. Include more critical analysis of how your findings contribute to current understanding of Kawasaki Disease in South Asian populations. 8. The authors should strengthen the discussion by citing contemporary literature to explain why their study found unusually high rates of incomplete Kawasaki Disease (65%) and coronary involvement (95%) compared to global data, with particular focus on whether these findings reflect delayed diagnosis, regional genetic factors, or referral bias in their tertiary care setting. Reviewer #2: 1. The dose of Aspirin in the acute phase may also affect the coronary artery on follow-up. It needs to be kept under consideration and can be included if it varies. 2. The article is an addition to the previous studies where atypical Kawasaki is increasing now. ****** -->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: Zhenglin chang Reviewer #2: Yes: Dr.Gunjan Baweja ******** [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.0328443.r001
Revision 1
29 Jun 2025 Author Response Responses to the comments of the academic editor 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 Reviewer #2: Yes Response: We have now revised the manuscript to make this technically sound and the data now support the conclusion ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes Response: Thanks. We have revised the statistical analysis section to make this more appropriate and rigorous ________________________________________ 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 Response: Thanks. ________________________________________ 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 Response: Thanks.________________________________________ 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 manuscript examines Kawasaki Disease in children at a Bangladeshi tertiary care hospital, providing valuable data through detailed clinical and laboratory profiles of 40 cases. While the study's strengths include clear documentation of treatment outcomes, several concerns need addressing - notably the unusually high rates of incomplete KD and coronary abnormalities, statistical rigor, methodology clarity, and limited discussion of findings in context of current literature. With appropriate revisions, this work could meaningfully contribute to understanding KD in Bangladesh. Response: Thanks for your constructive review comments. We have revised the manuscript following your kind suggestions. Major Comments: 1. While several laboratory tests were performed (CBC, ESR, CRP, SGPT, S. creatinine, blood C/S, Urine R/ME, C/S), the Results section only presents and analyzes a limited subset of these findings, primarily focusing on CRP, ESR, and CBC parameters. The data from other tests like SGPT, creatinine, blood culture, and urinalysis are mentioned in Methods but not reported or analyzed in the Results. To maintain scientific rigor and completeness, either all laboratory data should be presented and analyzed to justify the term "laboratory profiles" in the title, or the title should be modified to reflect the actual scope of reported findings. Response: Thanks. We have provided the information of all mentioned investigations in the results (page 6 under table 1). 2. Your introduction requires updating with literature from 2022-2024 to better contextualize your findings within current Kawasaki Disease research. We recommend incorporating recent epidemiological data (especially from South Asia), modern diagnostic approaches, and contemporary treatment outcomes. While retaining seminal papers, please replace pre-2015 references with current evidence on regional epidemiology, diagnostic criteria, and treatment guidelines to strengthen your manuscript's relevance and contribution to the field. Response: Thanks. We have revised the introduction section according to your kind suggestions on pages 3 & 3 under introduction. 3. Clarify diagnostic criteria used for incomplete KD. Response: Thanks. It is now mentioned on pages 4 and 5 under section material and methods section. 4. The statistical methodology requires significant revision. While P-values are presented, the specific statistical tests used are not specified, and there is no sample size calculation or power analysis. The authors should clearly state which statistical tests were employed and provide justification for the sample size to ensure scientific validity. Response: Thanks. This is an exploratory study where we enrolled all the children (n=40) diagnosed with KD between June 2019 to April 2023. However, we have performed the sample size calculation which has been mentioned on page under sample size on page 5. We have also done the power analysis of the study which is discussed on page 14, prior conclusion, under discussion section. Moreover, we have revised the statistical analysis plan according to the suggestion of the respected reviewer. 5. Add multivariate analysis of risk factors for coronary involvement. Response: Thanks. We have introduced multiple logistic regression and mentioned this in the statistical analysis plan on page 6 (first paragraph) and results section (table V, page 10 on results section) 6. Figure 1 is overly simple - additional figures showing key findings would be valuable. Response: Thanks. We have deleted this figure as this information is available in the results on page 6. 7. The Discussion section needs substantial revision as it currently focuses too heavily on restating results rather than interpretation and context. We recommend reducing the descriptive content of findings and expanding the analytical discussion, particularly comparing your results with contemporary literature and explaining the high rates of incomplete KD and coronary involvement observed in your study. Include more critical analysis of how your findings contribute to current understanding of Kawasaki Disease in South Asian populations. Response: Thanks. We have revised discussion section on pages 11 to 13 addressing the above-mentioned suggestions. 8. The authors should strengthen the discussion by citing contemporary literature to explain why their study found unusually high rates of incomplete Kawasaki Disease (65%) and coronary involvement (95%) compared to global data, with particular focus on whether these findings reflect delayed diagnosis, regional genetic factors, or referral bias in their tertiary care setting. Response: Thanks. We have done this accordingly throughout the manuscript and also in the reference list. Reviewer #2: 1. The dose of Aspirin in the acute phase may also affect the coronary artery on follow-up. It needs to be kept under consideration and can be included if it varies. Response: Thanks. We concur with the concern of the respected reviewer and. It is important to mention that we have used adequate dose of aspirin and mentioned in table III. 2. The article is an addition to the previous studies where atypical Kawasaki is increasing now. Response: Many thanks for your positive comments. Attachments Attachment Submitted filename: Response to Reviewers_PONE-D-24-55276.docx https://doi.org/10.1371/journal.pone.0328443.r002
2 Jul 2025 Decision Letter - Jyoti Sharma, Editor Clinical & laboratory profiles and treatment outcome of Kawasaki Disease in children: Experience from a tertiary care hospital PONE-D-24-55276R1 Dear Dr.Chisti, 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, Jyoti Sharma Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you for thoughtfully addressing the reviewers' suggestions. The revisions have significantly enhanced the quality and clarity of the manuscript https://doi.org/10.1371/journal.pone.0328443.r003

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