Reviewer ’s report  
 
Title: Validation of a New Risk Score System for Non -variceal Upper Gastrointestinal Bleeding  
 
Version: 1 Date: 01 May 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable research questions? (Brief or other article types: is there a clear objective?)  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (includ ing controls and analysis protocols) appropriate for the 
objective?  
 
No - there are minor issues  
 
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not,  can further 
revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
 
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: * Have the authors responded adequately to each of the questions or 
concerns you raised in your comments?  
 
YES. T he authors have responded adequately in terms of my concerns about the retrospective 
design of the study and they recognize this as a limitation.  I understand that the paper under 
review is a preliminary study, and while the discussion does describe limit ations of the study, in 
order to make this absolutely clear for readers, I would prefer it if this sentence from the abstract, 
conclusion, could be revised as follows: e.g "This is a preliminary report of a new bleeding score 
which may predict 30 -day morta lity better than the other scoring systems. High -risk patients 
could be screened using this new scoring system to predict 30 -day mortality. The use of this 
scoring system seemed to improve the outcomes of non -variceal UGIB patients in this study, 
throug h proper management and intervention."  
 
Could I also suggest that line 302 is revised as follows: e.g. "Although this study has several 
limitations, we think that it has laid the foundation for larger, multi -centre, prospective studies of 
the utility of the  INBS scoring system.  Specifically, such studies would be designed to 
investigate whether carrying out early endoscopy, and second -look endoscopy on the basis of the 
degree of risk identified by this new scoring system can improve patient outcomes."  
 
The authors have added a reference in response to my request to include details about other 
work, which is more recent, which is helpful.  
 
* Have they also made changes to reflect their responses in the manuscript itself?  
 
YES, there are changes in the manuscri pt which reflect their responses.  
 
Some further revisions (minor, see above) are needed for clarity and readability e.g  line 301 
'because it weighs in' should be 'because it is weighted towards'?  
 
Abstract was partially redacted therefore I am unable to fu lly assess that text.  
 
* What is your overall impression of the revised manuscript?  
 
Suitable for publication with a few minor revisions for clarity.  
 
 
REQUESTED REVISIONS:  
 
Design - minor issues, these were addressed in the original review, and relate to the retrospective 
nature of the study. Provided the authors make it clear in the revised publication this is a 
preliminary study and larger prospective studies would be neede d to provide reproducible data 
and validate the scoring system, I have no further comments.  
 
Interpretation - I have suggested minor changes to the existing text to make it clear to the reader 
that this is a preliminary study. Otherwise the author's interp retation is reasonable.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
Additional revisions - I suggested a couple of minor revisions to improve the clarity and 
readability of paper.  May I suggest that paper would benefit from some additional editing for 
readability, and I have provided some examples below, although this is not exhaustive review 
and edit of the paper. I hope that my suggestions are well received - I understand that as I am a 
native English speaker some of these may seem to be subtle changes, but I beli eve that they 
might help the authors and the readers in conveying the message.   
 
e.g line 194: replace 'divide' with 'organise'.  
 
Discussion lines 221 ongoing "In this study we evaluated whether INBS is effective in predicting 
30 day mortality in NVUGIB pat ients and its utility in predicting rebleeding or hospitalisation 
duration".  
 
Line 228: " while therapies such as Helicobacter pylori eradication therapy and proton pump 
inhibitors might be expected to reduce peptic ulcers and decrease the mortality rate of  NVUGIB 
patients, studies show that the mortality rate is still high at 6% to 14% due to population ageing 
and the use of anti -platelet drugs."  
 
Line 236 " predict prognosis and direct appropriate treatment".  
 
Line 251 " the recent INBS".  Replace with "The INBS scoring system that we have developed 
provides clear criteria…"  
 
Line 256 "in contrast to previous scoring systems, the INBS included medical history including 
liver renal and heart failure, in addition to the objective metabolic and biochemical indica tors 
which we have described.  
 
Line 280. " Therefore classification of patients using INBS could be used as a tool to increase the 
probability…."  
 
Line 283.  " in Korea, tertiary medical care institutions properly and actively perform endoscopy 
in patients. Therefore it would be helpful for the doctors who perform such procedures ito have a 
classification standard score to help determine the appropriate timing of endoscopy…"  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to  assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to asses s the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do y ou hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no co mpeting interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with  
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Lic ense 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
Reviewer Publication Consent. I agree for my r eport to be made  available under an Open 
Access Creative Commons CC -BY License ( http://creativecommons.org/licenses/by/4.0 ) if this 
manuscript is accepted for publication. Any comments that I do not wish to be included in the 
published report have been inc luded as confidential comments to the editor,  which will not be 
published.If you are not happy for us to publish this report, please contact the edi torial of fice 
before completing the review.If you wish, you can include your name in your published report. 
Please note you must decide whether to include your name at the start of the process and  confirm 
this decision whenever prompted. If you change your decision later, we will not be able to 
publish your name.  
 
I agree to the terms of the CC -BY 4.0 license; pl ease do not publish my name with my report.  
(default)  
Reviewer ’s report  
 
Title: Validation of a New Risk Score System for Non -variceal Upper Gastrointestinal Bleeding  
 
Version: 1 Date: 01 May 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable research questions? (Brief or other article types: is there a clear objective?)  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (includ ing controls and analysis protocols) appropriate for the 
objective?  
 
No - there are minor issues  
 
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not,  can further 
revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
 
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: * Have the authors responded adequately to each of the questions or 
concerns you raised in your comments?  
 
YES. T he authors have responded adequately in terms of my concerns about the retrospective 
design of the study and they recognize this as a limitation.  I understand that the paper under 
review is a preliminary study, and while the discussion does describe limit ations of the study, in 
order to make this absolutely clear for readers, I would prefer it if this sentence from the abstract, 
conclusion, could be revised as follows: e.g "This is a preliminary report of a new bleeding score 
which may predict 30 -day morta lity better than the other scoring systems. High -risk patients 
could be screened using this new scoring system to predict 30 -day mortality. The use of this 
scoring system seemed to improve the outcomes of non -variceal UGIB patients in this study, 
throug h proper management and intervention."  
 
Could I also suggest that line 302 is revised as follows: e.g. "Although this study has several 
limitations, we think that it has laid the foundation for larger, multi -centre, prospective studies of 
the utility of the  INBS scoring system.  Specifically, such studies would be designed to 
investigate whether carrying out early endoscopy, and second -look endoscopy on the basis of the 
degree of risk identified by this new scoring system can improve patient outcomes."  
 
The authors have added a reference in response to my request to include details about other 
work, which is more recent, which is helpful.  
 
* Have they also made changes to reflect their responses in the manuscript itself?  
 
YES, there are changes in the manuscri pt which reflect their responses.  
 
Some further revisions (minor, see above) are needed for clarity and readability e.g  line 301 
'because it weighs in' should be 'because it is weighted towards'?  
 
Abstract was partially redacted therefore I am unable to fu lly assess that text.  
 
* What is your overall impression of the revised manuscript?  
 
Suitable for publication with a few minor revisions for clarity.  
 
 
REQUESTED REVISIONS:  
 
Design - minor issues, these were addressed in the original review, and relate to the retrospective 
nature of the study. Provided the authors make it clear in the revised publication this is a 
preliminary study and larger prospective studies would be neede d to provide reproducible data 
and validate the scoring system, I have no further comments.  
 
Interpretation - I have suggested minor changes to the existing text to make it clear to the reader 
that this is a preliminary study. Otherwise the author's interp retation is reasonable.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
Additional revisions - I suggested a couple of minor revisions to improve the clarity and 
readability of paper.  May I suggest that paper would benefit from some additional editing for 
readability, and I have provided some examples below, although this is not exhaustive review 
and edit of the paper. I hope that my suggestions are well received - I understand that as I am a 
native English speaker some of these may seem to be subtle changes, but I beli eve that they 
might help the authors and the readers in conveying the message.   
 
e.g line 194: replace 'divide' with 'organise'.  
 
Discussion lines 221 ongoing "In this study we evaluated whether INBS is effective in predicting 
30 day mortality in NVUGIB pat ients and its utility in predicting rebleeding or hospitalisation 
duration".  
 
Line 228: " while therapies such as Helicobacter pylori eradication therapy and proton pump 
inhibitors might be expected to reduce peptic ulcers and decrease the mortality rate of  NVUGIB 
patients, studies show that the mortality rate is still high at 6% to 14% due to population ageing 
and the use of anti -platelet drugs."  
 
Line 236 " predict prognosis and direct appropriate treatment".  
 
Line 251 " the recent INBS".  Replace with "The INBS scoring system that we have developed 
provides clear criteria…"  
 
Line 256 "in contrast to previous scoring systems, the INBS included medical history including 
liver renal and heart failure, in addition to the objective metabolic and biochemical indica tors 
which we have described.  
 
Line 280. " Therefore classification of patients using INBS could be used as a tool to increase the 
probability…."  
 
Line 283.  " in Korea, tertiary medical care institutions properly and actively perform endoscopy 
in patients. Therefore it would be helpful for the doctors who perform such procedures ito have a 
classification standard score to help determine the appropriate timing of endoscopy…"  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to  assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to asses s the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do y ou hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no co mpeting interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with  
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Lic ense 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
Reviewer Publication Consent. I agree for my r eport to be made  available under an Open 
Access Creative Commons CC -BY License ( http://creativecommons.org/licenses/by/4.0 ) if this 
manuscript is accepted for publication. Any comments that I do not wish to be included in the 
published report have been inc luded as confidential comments to the editor,  which will not be 
published.If you are not happy for us to publish this report, please contact the edi torial of fice 
before completing the review.If you wish, you can include your name in your published report. 
Please note you must decide whether to include your name at the start of the process and  confirm 
this decision whenever prompted. If you change your decision later, we will not be able to 
publish your name.  
 
I agree to the terms of the CC -BY 4.0 license; pl ease do not publish my name with my report.  
(default)  
Please review this paper.
user
Reviewer ’s report  
 
Title: Validation of a New Risk Score System for Non -variceal Upper Gastrointestinal Bleeding  
 
Version: 1 Date: 01 May 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable research questions? (Brief or other article types: is there a clear objective?)  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (includ ing controls and analysis protocols) appropriate for the 
objective?  
 
No - there are minor issues  
 
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not,  can further 
revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
 
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: * Have the authors responded adequately to each of the questions or 
concerns you raised in your comments?  
 
YES. T he authors have responded adequately in terms of my concerns about the retrospective 
design of the study and they recognize this as a limitation.  I understand that the paper under 
review is a preliminary study, and while the discussion does describe limit ations of the study, in 
order to make this absolutely clear for readers, I would prefer it if this sentence from the abstract, 
conclusion, could be revised as follows: e.g "This is a preliminary report of a new bleeding score 
which may predict 30 -day morta lity better than the other scoring systems. High -risk patients 
could be screened using this new scoring system to predict 30 -day mortality. The use of this 
scoring system seemed to improve the outcomes of non -variceal UGIB patients in this study, 
throug h proper management and intervention."  
 
Could I also suggest that line 302 is revised as follows: e.g. "Although this study has several 
limitations, we think that it has laid the foundation for larger, multi -centre, prospective studies of 
the utility of the  INBS scoring system.  Specifically, such studies would be designed to 
investigate whether carrying out early endoscopy, and second -look endoscopy on the basis of the 
degree of risk identified by this new scoring system can improve patient outcomes."  
 
The authors have added a reference in response to my request to include details about other 
work, which is more recent, which is helpful.  
 
* Have they also made changes to reflect their responses in the manuscript itself?  
 
YES, there are changes in the manuscri pt which reflect their responses.  
 
Some further revisions (minor, see above) are needed for clarity and readability e.g  line 301 
'because it weighs in' should be 'because it is weighted towards'?  
 
Abstract was partially redacted therefore I am unable to fu lly assess that text.  
 
* What is your overall impression of the revised manuscript?  
 
Suitable for publication with a few minor revisions for clarity.  
 
 
REQUESTED REVISIONS:  
 
Design - minor issues, these were addressed in the original review, and relate to the retrospective 
nature of the study. Provided the authors make it clear in the revised publication this is a 
preliminary study and larger prospective studies would be neede d to provide reproducible data 
and validate the scoring system, I have no further comments.  
 
Interpretation - I have suggested minor changes to the existing text to make it clear to the reader 
that this is a preliminary study. Otherwise the author's interp retation is reasonable.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
Additional revisions - I suggested a couple of minor revisions to improve the clarity and 
readability of paper.  May I suggest that paper would benefit from some additional editing for 
readability, and I have provided some examples below, although this is not exhaustive review 
and edit of the paper. I hope that my suggestions are well received - I understand that as I am a 
native English speaker some of these may seem to be subtle changes, but I beli eve that they 
might help the authors and the readers in conveying the message.   
 
e.g line 194: replace 'divide' with 'organise'.  
 
Discussion lines 221 ongoing "In this study we evaluated whether INBS is effective in predicting 
30 day mortality in NVUGIB pat ients and its utility in predicting rebleeding or hospitalisation 
duration".  
 
Line 228: " while therapies such as Helicobacter pylori eradication therapy and proton pump 
inhibitors might be expected to reduce peptic ulcers and decrease the mortality rate of  NVUGIB 
patients, studies show that the mortality rate is still high at 6% to 14% due to population ageing 
and the use of anti -platelet drugs."  
 
Line 236 " predict prognosis and direct appropriate treatment".  
 
Line 251 " the recent INBS".  Replace with "The INBS scoring system that we have developed 
provides clear criteria…"  
 
Line 256 "in contrast to previous scoring systems, the INBS included medical history including 
liver renal and heart failure, in addition to the objective metabolic and biochemical indica tors 
which we have described.  
 
Line 280. " Therefore classification of patients using INBS could be used as a tool to increase the 
probability…."  
 
Line 283.  " in Korea, tertiary medical care institutions properly and actively perform endoscopy 
in patients. Therefore it would be helpful for the doctors who perform such procedures ito have a 
classification standard score to help determine the appropriate timing of endoscopy…"  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to  assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to asses s the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do y ou hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no co mpeting interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with  
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Lic ense 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
Reviewer Publication Consent. I agree for my r eport to be made  available under an Open 
Access Creative Commons CC -BY License ( http://creativecommons.org/licenses/by/4.0 ) if this 
manuscript is accepted for publication. Any comments that I do not wish to be included in the 
published report have been inc luded as confidential comments to the editor,  which will not be 
published.If you are not happy for us to publish this report, please contact the edi torial of fice 
before completing the review.If you wish, you can include your name in your published report. 
Please note you must decide whether to include your name at the start of the process and  confirm 
this decision whenever prompted. If you change your decision later, we will not be able to 
publish your name.  
 
I agree to the terms of the CC -BY 4.0 license; pl ease do not publish my name with my report.  
(default)  
assistant