Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

Round 1

Reviewer 1 Report

"Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study" is an interesting paper and should be published,

but it needs some corrections:

- the language style should improved

- introduction, design & conclusion should be exetended

Author Response

Dear Chief-in-Editor and Reviewers:

    The enclosed title is an article of “Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study” by Yi-Hsuan Chen, Ming-Shun Hsieh, Sung-Yuan Hu, Shih-Che Huang, Che-An Tsai, and Yi-Chun Tsai. This paper is submitted to Journal of Personalized Medicine for publication under all of the authors’ consent as an original article in your journal. This paper has not been accepted or published by another journal.

    We believe this paper will be of particular interest in “Original Article” to your readers because emphysematous cystitis (EC) has a highly variable presentation and course ranging from asymptomatic to severe sepsis, and is a potentially life-threatening condition. This study aims to investigate the scores of EC to predict clinical outcomes.

    A total of 35 patients were studied, including 11 males (31.4%) and 24 females (68.6%), with a mean age of 69.1 ± 11.4 years. The hospital stay averaged 19.9 ± 15.5 days with an in-hospital mortality rate of 22.9%. The Mortality in Emergency Department Sepsis (MEDS) Score was 5.4 ± 4.7 for survivors and 11.8 ± 5.3 for non-survivors (p <0.001). For mortality risk prediction, the AUC of ROC was 0.819 for MEDS and 0.685 for Rapid Emergency Medicine Score (REMS). The hazard ratio of univariate and multivariate logistic regression analyses of REMS for EC patients revealed 1.457 (p = 0.011) and 1.374 (p = 0.025), respectively. MEDS (≥12) and REMS (≥10) would have higher mortality rates of 14.3% and 8.6%, respectively, in EC patients of our study.

    Further large-scale studies are required to develop a new scoring system to predict the mortality risk of EC using more significant case numbers of multicentric approaches in order to be able to perform powerful analyses in the future.

    Thank you for your appreciation to our manuscript. We made the detailed changes according to the reviewers’ comments, including language style and extending introduction, design, and conclusion, to strengthen our revised manuscript with “Track Changes”.

We hope you will appreciate our effort.

Thank you for your attention to our work.

Sincerely yours,

Sung-Yuan Hu, MD, PhD

Reviewer 2 Report

The paper by Yi-Hsuan Chen et al. (manuscript JPM 2192136) presents a monocentric retrospective study performed on a group of 35 patients with emphysematous cystitis retrieved over a period of 14 years in the database of the emergency department of a large veterans hospital. The authors performed a statistical analysis on deceased vs. non-deceased patients concerning demographic data, clinical and laboratory features, co-morbidities, univariate and multivariate logistic regression analyses of risk factors, and in particular they assessed the predictive power of several scoring systems for ranking emergency department patients with sepsis. Of the six scoring systems assessed in this study, the most relevant were MEDS (Mortality in Emergency Department Sepsis) and REMS (Rapid Emergency Medicine Score), although only the first one yielded statistically significant differences for the deceased vs. non-deceased group by the Mann-Whitney test, while only the second showed statistically significant differences in univariate regression analysis. The two scoring systems were further evaluated via receiver operating characteristics (ROC), Kaplan-Meier survival estimators and cluster discrimination plots. ROC analysis proved that MEDS provides a better equilibrium between sensitivity and specificity, while REMS, although specific, is completely insensitive. Overall these statistical analysis results are interesting and relevant for a clinical audience, therefore I would recommend publication in Journal of Personalized Medicine in the present form, with only minute text corrections as suggested in the attached pdf version sent along with this review.

Comments for author File: Comments.pdf

Author Response

Dear Chief-in-Editor and Reviewers:

    The enclosed title is an article of “Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study” by Yi-Hsuan Chen, Ming-Shun Hsieh, Sung-Yuan Hu, Shih-Che Huang, Che-An Tsai, and Yi-Chun Tsai. This paper is submitted to Journal of Personalized Medicine for publication under all of the authors’ consent as an original article in your journal. This paper has not been accepted or published by another journal.

    We believe this paper will be of particular interest in “Original Article” to your readers because emphysematous cystitis (EC) has a highly variable presentation and course ranging from asymptomatic to severe sepsis, and is a potentially life-threatening condition. This study aims to investigate the scores of EC to predict clinical outcomes.

    A total of 35 patients were studied, including 11 males (31.4%) and 24 females (68.6%), with a mean age of 69.1 ± 11.4 years. The hospital stay averaged 19.9 ± 15.5 days with an in-hospital mortality rate of 22.9%. The Mortality in Emergency Department Sepsis (MEDS) Score was 5.4 ± 4.7 for survivors and 11.8 ± 5.3 for non-survivors (p <0.001). For mortality risk prediction, the AUC of ROC was 0.819 for MEDS and 0.685 for Rapid Emergency Medicine Score (REMS). The hazard ratio of univariate and multivariate logistic regression analyses of REMS for EC patients revealed 1.457 (p = 0.011) and 1.374 (p = 0.025), respectively. MEDS (≥12) and REMS (≥10) would have higher mortality rates of 14.3% and 8.6%, respectively, in EC patients of our study.

    Further large-scale studies are required to develop a new scoring system to predict the mortality risk of EC using more significant case numbers of multicentric approaches in order to be able to perform powerful analyses in the future.

    Thank you for your appreciation to our manuscript. We made the detailed changes according to the reviewers’ comments, including language style and extending introduction, design, and conclusion, to strengthen our revised manuscript with “Track Changes”.

We hope you will appreciate our effort.

Thank you for your attention to our work.

Sincerely yours,

Sung-Yuan Hu, MD, PhD