Title: Immune-nutritional indicators predict short-term mortality in olderly patients after
emergency gastrointestinal surgery: a retrospective study
Version: 1 Date: 24 Nov 2024
Reviewer's report:
The manuscript titled "Immune-nutritional indicators predict short-term mortality in elderly
patients after emergency gastrointestinal surgery: a retrospective study" investigates the
prognostic value of immune-nutritional indicators in predicting 90-day mortality among elderly
patients undergoing emergency gastrointestinal surgery. Using a retrospective cohort of 4,120
patients, the study evaluates eight immune-nutritional indicators, including mGPS, HS-mGPS,
PNI, and COUNT, through statistical and machine learning methods like LASSO-Cox and
CoxBoost regression models. The findings suggest that immune-nutritional factors such as
mGPS, HS-mGPS, and PNI can serve as robust predictors for short-term mortality, with the
CoxBoost model showing superior performance (AUC = 0.78). A nomogram model was also
developed, demonstrating good predictive accuracy and calibration.
The manuscript provides valuable insights into the predictive potential of immune-nutritional
indicators for short-term mortality in elderly surgical patients. However, significant revisions are
needed to strengthen its scientific rigor, contextual relevance, and practical implications. Major
improvements in the literature review, external validation, and discussion of clinical applications
are essential before the manuscript can be considered for publication.
-  The manuscript requires an updated and broader review of recent literature. For
example: Integrate findings from DOI: 10.1016/j.sto.2024.102272 and DOI: 10.1097/
JS9.0000000000000783, which offer new insights into predictive indicators and their
applications in similar clinical contexts.
- The study lacks external validation, limiting its applicability to other populations and
settings.The single-center nature of the study introduces selection bias.
- The rationale for including specific indicators like NPS, given its poor predictive performance,
should be clarified.
- Please change the term"elderly" with "older patients", since elderly, as stated by WHO, would
be spregiative term.
- The study focuses solely on mortality without addressing postoperative complications, which
could provide a more holistic view of patient outcomes.
- The discussion section could benefit from a more critical appraisal of the clinical implications,
especially regarding how these predictive models could influence surgical decision-making and
postoperative care.
Title: Immune-nutritional indicators predict short-term mortality in olderly patients after
emergency gastrointestinal surgery: a retrospective study
Version: 1 Date: 24 Nov 2024
Reviewer's report:
The manuscript titled "Immune-nutritional indicators predict short-term mortality in elderly
patients after emergency gastrointestinal surgery: a retrospective study" investigates the
prognostic value of immune-nutritional indicators in predicting 90-day mortality among elderly
patients undergoing emergency gastrointestinal surgery. Using a retrospective cohort of 4,120
patients, the study evaluates eight immune-nutritional indicators, including mGPS, HS-mGPS,
PNI, and COUNT, through statistical and machine learning methods like LASSO-Cox and
CoxBoost regression models. The findings suggest that immune-nutritional factors such as
mGPS, HS-mGPS, and PNI can serve as robust predictors for short-term mortality, with the
CoxBoost model showing superior performance (AUC = 0.78). A nomogram model was also
developed, demonstrating good predictive accuracy and calibration.
The manuscript provides valuable insights into the predictive potential of immune-nutritional
indicators for short-term mortality in elderly surgical patients. However, significant revisions are
needed to strengthen its scientific rigor, contextual relevance, and practical implications. Major
improvements in the literature review, external validation, and discussion of clinical applications
are essential before the manuscript can be considered for publication.
-  The manuscript requires an updated and broader review of recent literature. For
example: Integrate findings from DOI: 10.1016/j.sto.2024.102272 and DOI: 10.1097/
JS9.0000000000000783, which offer new insights into predictive indicators and their
applications in similar clinical contexts.
- The study lacks external validation, limiting its applicability to other populations and
settings.The single-center nature of the study introduces selection bias.
- The rationale for including specific indicators like NPS, given its poor predictive performance,
should be clarified.
- Please change the term"elderly" with "older patients", since elderly, as stated by WHO, would
be spregiative term.
- The study focuses solely on mortality without addressing postoperative complications, which
could provide a more holistic view of patient outcomes.
- The discussion section could benefit from a more critical appraisal of the clinical implications,
especially regarding how these predictive models could influence surgical decision-making and
postoperative care.
Please review this paper.
user
Title: Immune-nutritional indicators predict short-term mortality in olderly patients after
emergency gastrointestinal surgery: a retrospective study
Version: 1 Date: 24 Nov 2024
Reviewer's report:
The manuscript titled "Immune-nutritional indicators predict short-term mortality in elderly
patients after emergency gastrointestinal surgery: a retrospective study" investigates the
prognostic value of immune-nutritional indicators in predicting 90-day mortality among elderly
patients undergoing emergency gastrointestinal surgery. Using a retrospective cohort of 4,120
patients, the study evaluates eight immune-nutritional indicators, including mGPS, HS-mGPS,
PNI, and COUNT, through statistical and machine learning methods like LASSO-Cox and
CoxBoost regression models. The findings suggest that immune-nutritional factors such as
mGPS, HS-mGPS, and PNI can serve as robust predictors for short-term mortality, with the
CoxBoost model showing superior performance (AUC = 0.78). A nomogram model was also
developed, demonstrating good predictive accuracy and calibration.
The manuscript provides valuable insights into the predictive potential of immune-nutritional
indicators for short-term mortality in elderly surgical patients. However, significant revisions are
needed to strengthen its scientific rigor, contextual relevance, and practical implications. Major
improvements in the literature review, external validation, and discussion of clinical applications
are essential before the manuscript can be considered for publication.
-  The manuscript requires an updated and broader review of recent literature. For
example: Integrate findings from DOI: 10.1016/j.sto.2024.102272 and DOI: 10.1097/
JS9.0000000000000783, which offer new insights into predictive indicators and their
applications in similar clinical contexts.
- The study lacks external validation, limiting its applicability to other populations and
settings.The single-center nature of the study introduces selection bias.
- The rationale for including specific indicators like NPS, given its poor predictive performance,
should be clarified.
- Please change the term"elderly" with "older patients", since elderly, as stated by WHO, would
be spregiative term.
- The study focuses solely on mortality without addressing postoperative complications, which
could provide a more holistic view of patient outcomes.
- The discussion section could benefit from a more critical appraisal of the clinical implications,
especially regarding how these predictive models could influence surgical decision-making and
postoperative care.
assistant