-->PONE-D-25-48342-->-->NephroPOC - Risk assessment and prediction of acute kidney injury in emergency patients with suspected organ dysfunction: secondary analysis from the prospective observational LifePOC study-->-->PLOS ONE

Dear Dr. Neumann,

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.

This is an interesting novel biomarkers for acute kidney injury with well design study. There are only minor comments from the reviewers. Please carefully response to the reviewers' comments and suggestions.

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We look forward to receiving your revised manuscript.

Kind regards,

Vipa Thanachartwet, M.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

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-->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

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

Reviewer #1: I Don't Know

Reviewer #2: 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

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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

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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: Thank you for submitting this article. It is interesting to read about this specific biomarker. I think the discussion could include more about the benefits of the use of the biomarker over clinician knowledge.

Reviewer #2: PLOS ONE

October 1, 2025

Manuscript ID: PONE-D-25-48342

Manuscript title: NephroPOC - Risk assessment and prediction of acute kidney injury in emergency patients with suspected organ dysfunction: secondary analysis from the prospective observational LifePOC study

Dear Prof. Thanachartwet,

This study was conducted as a well design study with the aim to assess markers and risk factors for imminent acute kidney injury (AKI) in emergency patients. The results from this study could be used as a novel biomarkers for predicting acute kidney injury in future.

However, there are some comments for this manuscript to address as follows:

1. Currently, there are several biomarkers for AKI. Are there any evidence to support that biomarkers including penKid, ADM, DPP-3 and PCT have the advantage over the previous biomarkers such as Cystatin C, NGAL, KIM-1 or etc. for predicting AKI?

2. Regarding Table S5: Prediction of AKI within 48h using admission biomarkers and GFR estimates: Net reclassification improvement based on GFR categories, this table compared eGFR by CKD-EPI and PENK-based equation according to REF #25. This PENK-based equation arise from the international multicenter study of 1,354 stable and critically ill patients with stable kidney function. In this study, GFR was measured (mGFR) through iohexol or iothalamate clearance which is the gold standard method for measuring GFR. It is wonder how PENK-based equation can be used to estimate GFR in AKI patients. Additionally, how CKD-EPI can estimate true GFR in AKI patients as CKD-EPI is not gold standard for measuring GFR? Thus, eGFR categories by PENK-Crea and CKD-EPI in the Tale S5 should be analysed by the test of agreement.

3. P-value throughout the manuscript should be round to the 3 digits after the decimal point.

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-->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.

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Reviewer #1: No

Reviewer #2: Yes:  Assoc. Prof. Varunee Desakorn

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-->

NephroPOC - Risk assessment and prediction of acute kidney injury in emergency patients with suspected organ dysfunction: secondary analysis from the prospective observational LifePOC study

PONE-D-25-48342R1

Dear Dr. Neumann,

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,

Vipa Thanachartwet, M.D.

Academic Editor

PLOS One

Additional Editor Comments (optional):

All comments have been addressed.

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 #2: 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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: I Don't Know

Reviewer #2: 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 #2: 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 #2: 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: Thank you for making the suggested changes. This is an interesting article and I look forward to seeing it in print

Reviewer #2: (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 #1: No

Reviewer #2: Yes:  Assoc Prof. Varunee Desakorn

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