Title: Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients
and Actual Portal Pressure Gradient
Version: 2 Date: 28 Jan 2025
Reviewer's report:
The article by Rufeng Chen and Yaozu Liu et al. describes the correlations and relationships
between different wedged and free pressure measurements for HVPG and PPG-assessment prior
to and after TIPS implantation, respectively, including measurements within the liver vein and
the inferior caval vein.
The manuscript is very well written, concise and focusses on the topic.
The data were collected retrospectively, but - according to the authors - without sedation or
anaesthesia, which makes the measurements valuable.
The topic is clinically and scientifically of  interest, as HVPG (as an indirect measurement
of PPG) is the parameter that best correlates with outcome in patients with decompensated
cirrhosis. Correct assessment of PPG/PPG-estimation via HVPG is thus key to prognostication
and treatment of patients with cirrhosis.
Major comments:
- Most of the included patients suffered from HBV-associated cirrhosis and variceal bleeding.
How many patients were under antiviral treatment, and how many of the patients under NSBB
prophylaxis or other vasoactive drugs (e.g. nitrates) at time of measurement? Were there any
differences between patients under medical treatment and those without?
- Please add a sentence on the stated fact that TIPS were performed under local anaesthesia and
without sedation or general anaesthesia to the section "Measurement of HVPG and PPG" under
"Materials and Methods"
- Who performed the HVPG measurements and TIPS procedures? Was it hepatologists
or radiologists? Were all procedures performed by the same specialist, or how many
interventionists were involved? If more than one was involved, were there any significant inter-
intervenionist differences regarding technique or outcome parameters?
- Did any patients undergo rescue TIPS due to refractory bleeding, undergo BRTO or receive
coagulation factors, fresh frozen plasma or platelet concentrates prior to TIPS implantation?
- If there are any data available: How many patients actively consumed alcohol or smoked prior
to TIPS?
Minor comments:
- How many patients had both moderate ascites and variceal bleeding as indications for
TIPS? When patients with high-grade ascites were excluded, was abdominal paracentesis not
performed prior to TIPS insertion? And why was ascites still the indication for TIPS in 19%?
- I kindly ask the authors to check for inconsistencies with regards to abbreviations; e.g. are F-
HVPG, HVPG-free and HVPGfhvp the same value? Please unify the abbreviations throughout
the manuscript.
- Similarly, I kindly ask the authors to check the figures and adapt them regarding sizes (e.g.
Figure 4a A and B) and y-axis scaling (e.g. figures 2b C and D) for better comparability where
appropriate.
- On a related note, I suggest writing FHVP and IVCP in Figure-1 in capital letters for
consistency.
Title: Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients
and Actual Portal Pressure Gradient
Version: 2 Date: 28 Jan 2025
Reviewer's report:
The article by Rufeng Chen and Yaozu Liu et al. describes the correlations and relationships
between different wedged and free pressure measurements for HVPG and PPG-assessment prior
to and after TIPS implantation, respectively, including measurements within the liver vein and
the inferior caval vein.
The manuscript is very well written, concise and focusses on the topic.
The data were collected retrospectively, but - according to the authors - without sedation or
anaesthesia, which makes the measurements valuable.
The topic is clinically and scientifically of  interest, as HVPG (as an indirect measurement
of PPG) is the parameter that best correlates with outcome in patients with decompensated
cirrhosis. Correct assessment of PPG/PPG-estimation via HVPG is thus key to prognostication
and treatment of patients with cirrhosis.
Major comments:
- Most of the included patients suffered from HBV-associated cirrhosis and variceal bleeding.
How many patients were under antiviral treatment, and how many of the patients under NSBB
prophylaxis or other vasoactive drugs (e.g. nitrates) at time of measurement? Were there any
differences between patients under medical treatment and those without?
- Please add a sentence on the stated fact that TIPS were performed under local anaesthesia and
without sedation or general anaesthesia to the section "Measurement of HVPG and PPG" under
"Materials and Methods"
- Who performed the HVPG measurements and TIPS procedures? Was it hepatologists
or radiologists? Were all procedures performed by the same specialist, or how many
interventionists were involved? If more than one was involved, were there any significant inter-
intervenionist differences regarding technique or outcome parameters?
- Did any patients undergo rescue TIPS due to refractory bleeding, undergo BRTO or receive
coagulation factors, fresh frozen plasma or platelet concentrates prior to TIPS implantation?
- If there are any data available: How many patients actively consumed alcohol or smoked prior
to TIPS?
Minor comments:
- How many patients had both moderate ascites and variceal bleeding as indications for
TIPS? When patients with high-grade ascites were excluded, was abdominal paracentesis not
performed prior to TIPS insertion? And why was ascites still the indication for TIPS in 19%?
- I kindly ask the authors to check for inconsistencies with regards to abbreviations; e.g. are F-
HVPG, HVPG-free and HVPGfhvp the same value? Please unify the abbreviations throughout
the manuscript.
- Similarly, I kindly ask the authors to check the figures and adapt them regarding sizes (e.g.
Figure 4a A and B) and y-axis scaling (e.g. figures 2b C and D) for better comparability where
appropriate.
- On a related note, I suggest writing FHVP and IVCP in Figure-1 in capital letters for
consistency.
Please review this paper.
user
Title: Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients
and Actual Portal Pressure Gradient
Version: 2 Date: 28 Jan 2025
Reviewer's report:
The article by Rufeng Chen and Yaozu Liu et al. describes the correlations and relationships
between different wedged and free pressure measurements for HVPG and PPG-assessment prior
to and after TIPS implantation, respectively, including measurements within the liver vein and
the inferior caval vein.
The manuscript is very well written, concise and focusses on the topic.
The data were collected retrospectively, but - according to the authors - without sedation or
anaesthesia, which makes the measurements valuable.
The topic is clinically and scientifically of  interest, as HVPG (as an indirect measurement
of PPG) is the parameter that best correlates with outcome in patients with decompensated
cirrhosis. Correct assessment of PPG/PPG-estimation via HVPG is thus key to prognostication
and treatment of patients with cirrhosis.
Major comments:
- Most of the included patients suffered from HBV-associated cirrhosis and variceal bleeding.
How many patients were under antiviral treatment, and how many of the patients under NSBB
prophylaxis or other vasoactive drugs (e.g. nitrates) at time of measurement? Were there any
differences between patients under medical treatment and those without?
- Please add a sentence on the stated fact that TIPS were performed under local anaesthesia and
without sedation or general anaesthesia to the section "Measurement of HVPG and PPG" under
"Materials and Methods"
- Who performed the HVPG measurements and TIPS procedures? Was it hepatologists
or radiologists? Were all procedures performed by the same specialist, or how many
interventionists were involved? If more than one was involved, were there any significant inter-
intervenionist differences regarding technique or outcome parameters?
- Did any patients undergo rescue TIPS due to refractory bleeding, undergo BRTO or receive
coagulation factors, fresh frozen plasma or platelet concentrates prior to TIPS implantation?
- If there are any data available: How many patients actively consumed alcohol or smoked prior
to TIPS?
Minor comments:
- How many patients had both moderate ascites and variceal bleeding as indications for
TIPS? When patients with high-grade ascites were excluded, was abdominal paracentesis not
performed prior to TIPS insertion? And why was ascites still the indication for TIPS in 19%?
- I kindly ask the authors to check for inconsistencies with regards to abbreviations; e.g. are F-
HVPG, HVPG-free and HVPGfhvp the same value? Please unify the abbreviations throughout
the manuscript.
- Similarly, I kindly ask the authors to check the figures and adapt them regarding sizes (e.g.
Figure 4a A and B) and y-axis scaling (e.g. figures 2b C and D) for better comparability where
appropriate.
- On a related note, I suggest writing FHVP and IVCP in Figure-1 in capital letters for
consistency.
assistant