Reviewer's report
 
 Utility of the Mayo End-Stage Liver Disease(MELD) score in assessing Title:
prognosis of patients with alcoholic hepatitis
Authors:
Milan Sheth (msheth@swmail.sw.org )
Mark Riggs ( mriggs@swmail.sw.org )
Tushar Patel (tpatel@medicine.tamu.edu )
 2  26 Dec 2001 Version: Date:
 Dr Yoshiyuki Ueno Reviewer:
 A paper of considerable general medical or scientific interest Level of interest:
 Accept after discretionary revisions Advice on publication:
In this report, the authors examine the validity of the Model for End-Stage Liver 
Disease (MELD) score as a disease severity index for patients with alcoholic 
hepatitis. This model was originally developed to assess the short-term prognosis of 
patients with cirrhosis undergoing the transjugular intrahepatic portosystemic shunt 
(TIPS) procedure. While its development was based on a highly selected subgroup of patients with cirrhosis, the model is able to provide a reliable estimate of short-term survival over a wide range of liver disease severity and diverse etiology. 
While the previous model to evaluate prognosis of patients with alcoholic hepatitis 
was discriminant function (DF), which utilize prothrombin time (PT). As authors 
mentioned, the PT is not universal value and tends to be replaced by INR. Thus it is 
important to evaluated the efficacy of MELD in patients with alcoholic hepatitis. 
Moreover, the authors' major findings: i) close co-relation between MELD and DF, ii) 
simple clinical observation - the presence of both ascites and an elevated bilirubin 
greater than 8 mg/dL indicated poor clinical outcome, are quite useful in clinical decision making. Hence, this important report will provide quite important information
for hepatologists in not only transplant center but also in usual hepatobiliary clinic of 
medical urgency who require a more refined model that accurately represents disease severity. 
Very few further information will provide more strength of this reports such as: 1) 
patients' disease backgrounds (i.e. how many percentage of patients were acute alcoholic hepatitis and same for acute exacerbation of chronic alcoholic hepatitis?), 2) percentage of patients undergoing liver biopsy and the results of pathological 
findings. 
Apart from these questions, I believe this study will provide strong rationale for the usage of MELD in stead of DF, which was introduced almost twenty years ago whenother etiologies such as hepatitis C could not be ruled out. 
Competing interests:
None declared.
Reviewer's report
 
 Utility of the Mayo End-Stage Liver Disease(MELD) score in assessing Title:
prognosis of patients with alcoholic hepatitis
Authors:
Milan Sheth (msheth@swmail.sw.org )
Mark Riggs ( mriggs@swmail.sw.org )
Tushar Patel (tpatel@medicine.tamu.edu )
 2  26 Dec 2001 Version: Date:
 Dr Yoshiyuki Ueno Reviewer:
 A paper of considerable general medical or scientific interest Level of interest:
 Accept after discretionary revisions Advice on publication:
In this report, the authors examine the validity of the Model for End-Stage Liver 
Disease (MELD) score as a disease severity index for patients with alcoholic 
hepatitis. This model was originally developed to assess the short-term prognosis of 
patients with cirrhosis undergoing the transjugular intrahepatic portosystemic shunt 
(TIPS) procedure. While its development was based on a highly selected subgroup of patients with cirrhosis, the model is able to provide a reliable estimate of short-term survival over a wide range of liver disease severity and diverse etiology. 
While the previous model to evaluate prognosis of patients with alcoholic hepatitis 
was discriminant function (DF), which utilize prothrombin time (PT). As authors 
mentioned, the PT is not universal value and tends to be replaced by INR. Thus it is 
important to evaluated the efficacy of MELD in patients with alcoholic hepatitis. 
Moreover, the authors' major findings: i) close co-relation between MELD and DF, ii) 
simple clinical observation - the presence of both ascites and an elevated bilirubin 
greater than 8 mg/dL indicated poor clinical outcome, are quite useful in clinical decision making. Hence, this important report will provide quite important information
for hepatologists in not only transplant center but also in usual hepatobiliary clinic of 
medical urgency who require a more refined model that accurately represents disease severity. 
Very few further information will provide more strength of this reports such as: 1) 
patients' disease backgrounds (i.e. how many percentage of patients were acute alcoholic hepatitis and same for acute exacerbation of chronic alcoholic hepatitis?), 2) percentage of patients undergoing liver biopsy and the results of pathological 
findings. 
Apart from these questions, I believe this study will provide strong rationale for the usage of MELD in stead of DF, which was introduced almost twenty years ago whenother etiologies such as hepatitis C could not be ruled out. 
Competing interests:
None declared.
Please review this paper.
user
Reviewer's report
 
 Utility of the Mayo End-Stage Liver Disease(MELD) score in assessing Title:
prognosis of patients with alcoholic hepatitis
Authors:
Milan Sheth (msheth@swmail.sw.org )
Mark Riggs ( mriggs@swmail.sw.org )
Tushar Patel (tpatel@medicine.tamu.edu )
 2  26 Dec 2001 Version: Date:
 Dr Yoshiyuki Ueno Reviewer:
 A paper of considerable general medical or scientific interest Level of interest:
 Accept after discretionary revisions Advice on publication:
In this report, the authors examine the validity of the Model for End-Stage Liver 
Disease (MELD) score as a disease severity index for patients with alcoholic 
hepatitis. This model was originally developed to assess the short-term prognosis of 
patients with cirrhosis undergoing the transjugular intrahepatic portosystemic shunt 
(TIPS) procedure. While its development was based on a highly selected subgroup of patients with cirrhosis, the model is able to provide a reliable estimate of short-term survival over a wide range of liver disease severity and diverse etiology. 
While the previous model to evaluate prognosis of patients with alcoholic hepatitis 
was discriminant function (DF), which utilize prothrombin time (PT). As authors 
mentioned, the PT is not universal value and tends to be replaced by INR. Thus it is 
important to evaluated the efficacy of MELD in patients with alcoholic hepatitis. 
Moreover, the authors' major findings: i) close co-relation between MELD and DF, ii) 
simple clinical observation - the presence of both ascites and an elevated bilirubin 
greater than 8 mg/dL indicated poor clinical outcome, are quite useful in clinical decision making. Hence, this important report will provide quite important information
for hepatologists in not only transplant center but also in usual hepatobiliary clinic of 
medical urgency who require a more refined model that accurately represents disease severity. 
Very few further information will provide more strength of this reports such as: 1) 
patients' disease backgrounds (i.e. how many percentage of patients were acute alcoholic hepatitis and same for acute exacerbation of chronic alcoholic hepatitis?), 2) percentage of patients undergoing liver biopsy and the results of pathological 
findings. 
Apart from these questions, I believe this study will provide strong rationale for the usage of MELD in stead of DF, which was introduced almost twenty years ago whenother etiologies such as hepatitis C could not be ruled out. 
Competing interests:
None declared.
assistant