Title: Abnormal ferritin levels predict development of poor outcomes in cirrhotic outpatients:
a cohort study
Version: 1 Date: 03 Jan 2021
Reviewer's report:
It is an interesting study about the role of ferritin on the prognosis of patients with liver disease
comments:
1. the manuscript has many grammar and syntax problems. Please try to correct them
2. In your study , patients with hepatocellular carcinoma were included. I think that this group
of patients should be excluded from the study. Presence of HCC changes the clinical and
inflammatory status of a patient. So it is wrong to  include in the same group of patients those
with and without HCC (per example compensated cirrhotic patients without HCC and those with
compensated cirrhosis and HCC).
3. You found that in compensated liver disease, low ferritin is related to increased risk for the
development of liver decompensation. On the other hand in patients with decompensated liver
cirrhosis, high ferritin levels were found to be related to an increased risk for bacterial infection.
You gave the following explanation: in the first group, the cause of low ferritin was probably
the subclinical bleeding due to the portal hypertension. In the latter group, the cause of high
ferritin was the liver insufficiency and the inflammation. However in both groups high ferritin
was related to worse outcome. It is obvious that in the group of compensated disease the results
are controversial (low ferritin increases the risk for decompensation but high ferritin worsens
the survival). It would be better for that reason to examine separately the compensated cirrhotic
patients who sustained in a compensation status during the 2 years period of follow up and on
the other hand the compensated cirrhotic patients who developed liver decompensation during
this period of time.
4. In the field of discussion you made a lot of speculations in order to explain and support your
results. Some of them are more comprehensive and some are less. It is hard for me to understand
your deduction in the 1st paragraph of page 24 : "Finally, the stronger correlation ........exactly
in this patient group". Please explain in a better way what do you mean.
Title: Abnormal ferritin levels predict development of poor outcomes in cirrhotic outpatients:
a cohort study
Version: 1 Date: 03 Jan 2021
Reviewer's report:
It is an interesting study about the role of ferritin on the prognosis of patients with liver disease
comments:
1. the manuscript has many grammar and syntax problems. Please try to correct them
2. In your study , patients with hepatocellular carcinoma were included. I think that this group
of patients should be excluded from the study. Presence of HCC changes the clinical and
inflammatory status of a patient. So it is wrong to  include in the same group of patients those
with and without HCC (per example compensated cirrhotic patients without HCC and those with
compensated cirrhosis and HCC).
3. You found that in compensated liver disease, low ferritin is related to increased risk for the
development of liver decompensation. On the other hand in patients with decompensated liver
cirrhosis, high ferritin levels were found to be related to an increased risk for bacterial infection.
You gave the following explanation: in the first group, the cause of low ferritin was probably
the subclinical bleeding due to the portal hypertension. In the latter group, the cause of high
ferritin was the liver insufficiency and the inflammation. However in both groups high ferritin
was related to worse outcome. It is obvious that in the group of compensated disease the results
are controversial (low ferritin increases the risk for decompensation but high ferritin worsens
the survival). It would be better for that reason to examine separately the compensated cirrhotic
patients who sustained in a compensation status during the 2 years period of follow up and on
the other hand the compensated cirrhotic patients who developed liver decompensation during
this period of time.
4. In the field of discussion you made a lot of speculations in order to explain and support your
results. Some of them are more comprehensive and some are less. It is hard for me to understand
your deduction in the 1st paragraph of page 24 : "Finally, the stronger correlation ........exactly
in this patient group". Please explain in a better way what do you mean.
Please review this paper.
user
Title: Abnormal ferritin levels predict development of poor outcomes in cirrhotic outpatients:
a cohort study
Version: 1 Date: 03 Jan 2021
Reviewer's report:
It is an interesting study about the role of ferritin on the prognosis of patients with liver disease
comments:
1. the manuscript has many grammar and syntax problems. Please try to correct them
2. In your study , patients with hepatocellular carcinoma were included. I think that this group
of patients should be excluded from the study. Presence of HCC changes the clinical and
inflammatory status of a patient. So it is wrong to  include in the same group of patients those
with and without HCC (per example compensated cirrhotic patients without HCC and those with
compensated cirrhosis and HCC).
3. You found that in compensated liver disease, low ferritin is related to increased risk for the
development of liver decompensation. On the other hand in patients with decompensated liver
cirrhosis, high ferritin levels were found to be related to an increased risk for bacterial infection.
You gave the following explanation: in the first group, the cause of low ferritin was probably
the subclinical bleeding due to the portal hypertension. In the latter group, the cause of high
ferritin was the liver insufficiency and the inflammation. However in both groups high ferritin
was related to worse outcome. It is obvious that in the group of compensated disease the results
are controversial (low ferritin increases the risk for decompensation but high ferritin worsens
the survival). It would be better for that reason to examine separately the compensated cirrhotic
patients who sustained in a compensation status during the 2 years period of follow up and on
the other hand the compensated cirrhotic patients who developed liver decompensation during
this period of time.
4. In the field of discussion you made a lot of speculations in order to explain and support your
results. Some of them are more comprehensive and some are less. It is hard for me to understand
your deduction in the 1st paragraph of page 24 : "Finally, the stronger correlation ........exactly
in this patient group". Please explain in a better way what do you mean.
assistant