Reviewer ’s report  
 
Title: Impact of visceral adiposity on severity of acute pancreatitis: a propensity sco re-matched 
analysis  
 
Version: 0 Date: 20 Dec 2018  
 
Reviewer: Pankaj Gupta  
 
Reviewer's report:  
 
General comments: - 
In the methodology, CT techniqu e needs to be elaborated  
Also few more epidemiological details need to be highlighted (please see specific comments)  
The discussion part is unfocused and needs to be rewritten  
Specific comments: - 
Page 5, line 51: please add reference  
Page 5, line 54: please write reference [11, 12, 13, 14] as [11 -14] 
Page 5, line 57: please add reference  
Page 7, line 26: Could the authors also evaluate the other important variables including need for 
surgery, drainage (percutaneous or endoscopic). How many patients (in either group) needed 
hospital admission. It is understandable that most if not all patients in the SAP and MSAP group 
would have had admission, however, what about the MAP.   
Page 7, line 43: Kindly elaborate on the CT. What was the scann er used for image acquisition. 
Was the acquisition of entire abdomen or a limited region of abdomen done? Is CT done 
routinely within 24 hours of the admission for patients with pancreatitis in authors' institute. Are 
they routinely performing unenhanced C T for pancreatitis. Was the categorisation of local 
complications viz. APFC, ANC, WON and pseudocyst done on this CT? If not what was the 
detailed protocol for performing follow up CT scans. Why did the authors opt to choose adobe 
software for measuring th e cross -sectional area of fat and what limits of Hounsfield units did 
they select for identification of fat.  
Page 8, line 48: What was the most common etiology of pancreatitis. Did the authors note the 
proportion of patients with pancreatitis with hyperli pidemia.  
Page 9, line 28: What is MT?  
Page 10, line 3: When you refer to AP severity -are you referring to combined SAP and MSAP 
group or SAP alone. It would be of interest to rather investigate whether these cut -off give the 
same high sensitivity and spec ificity for predicting local complications particularly WOPN as 
well as the need for ICU stay and duration of hospital stay, May I request the authors to provide 
ROC curves for these parameters.  
Page 10, line 54: This recommendation is difficult to endors e as it is less likely for a patient to 
report to a tertiary care/ teaching institute within 24 hours of pain onset. Even if they report, CT 
scan within 24 hours is not justified as the other key information about the extent of pancreatic 
necrosis and loca l complications will not be obtained. The recommendation for performing a 
limited unenhanced CT at a particular level of abdomen needs to be based on a multicentre 
prospective study with randomisation.  
Page 11, line 4: Please provide references. It may be  of interest to cite few recent systematic 
reviews or meta -analysis.  
Page 11, line 20: please rephrase  
Page 11, line 23: remove repetition  
Page 11, line 29 and 31: This was not highlighted in the results section  
References 3, 5, 10, 18: cite properly  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify wh at is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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 manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess 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 declarat ion of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript,  either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 pat ents 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 competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license (http://creativecommons.org/licenses/by/4.0/ ). I understand that any co mments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Impact of visceral adiposity on severity of acute pancreatitis: a propensity sco re-matched 
analysis  
 
Version: 0 Date: 20 Dec 2018  
 
Reviewer: Pankaj Gupta  
 
Reviewer's report:  
 
General comments: - 
In the methodology, CT techniqu e needs to be elaborated  
Also few more epidemiological details need to be highlighted (please see specific comments)  
The discussion part is unfocused and needs to be rewritten  
Specific comments: - 
Page 5, line 51: please add reference  
Page 5, line 54: please write reference [11, 12, 13, 14] as [11 -14] 
Page 5, line 57: please add reference  
Page 7, line 26: Could the authors also evaluate the other important variables including need for 
surgery, drainage (percutaneous or endoscopic). How many patients (in either group) needed 
hospital admission. It is understandable that most if not all patients in the SAP and MSAP group 
would have had admission, however, what about the MAP.   
Page 7, line 43: Kindly elaborate on the CT. What was the scann er used for image acquisition. 
Was the acquisition of entire abdomen or a limited region of abdomen done? Is CT done 
routinely within 24 hours of the admission for patients with pancreatitis in authors' institute. Are 
they routinely performing unenhanced C T for pancreatitis. Was the categorisation of local 
complications viz. APFC, ANC, WON and pseudocyst done on this CT? If not what was the 
detailed protocol for performing follow up CT scans. Why did the authors opt to choose adobe 
software for measuring th e cross -sectional area of fat and what limits of Hounsfield units did 
they select for identification of fat.  
Page 8, line 48: What was the most common etiology of pancreatitis. Did the authors note the 
proportion of patients with pancreatitis with hyperli pidemia.  
Page 9, line 28: What is MT?  
Page 10, line 3: When you refer to AP severity -are you referring to combined SAP and MSAP 
group or SAP alone. It would be of interest to rather investigate whether these cut -off give the 
same high sensitivity and spec ificity for predicting local complications particularly WOPN as 
well as the need for ICU stay and duration of hospital stay, May I request the authors to provide 
ROC curves for these parameters.  
Page 10, line 54: This recommendation is difficult to endors e as it is less likely for a patient to 
report to a tertiary care/ teaching institute within 24 hours of pain onset. Even if they report, CT 
scan within 24 hours is not justified as the other key information about the extent of pancreatic 
necrosis and loca l complications will not be obtained. The recommendation for performing a 
limited unenhanced CT at a particular level of abdomen needs to be based on a multicentre 
prospective study with randomisation.  
Page 11, line 4: Please provide references. It may be  of interest to cite few recent systematic 
reviews or meta -analysis.  
Page 11, line 20: please rephrase  
Page 11, line 23: remove repetition  
Page 11, line 29 and 31: This was not highlighted in the results section  
References 3, 5, 10, 18: cite properly  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify wh at is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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 manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess 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 declarat ion of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript,  either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 pat ents 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 competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license (http://creativecommons.org/licenses/by/4.0/ ). I understand that any co mments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Impact of visceral adiposity on severity of acute pancreatitis: a propensity sco re-matched 
analysis  
 
Version: 0 Date: 20 Dec 2018  
 
Reviewer: Pankaj Gupta  
 
Reviewer's report:  
 
General comments: - 
In the methodology, CT techniqu e needs to be elaborated  
Also few more epidemiological details need to be highlighted (please see specific comments)  
The discussion part is unfocused and needs to be rewritten  
Specific comments: - 
Page 5, line 51: please add reference  
Page 5, line 54: please write reference [11, 12, 13, 14] as [11 -14] 
Page 5, line 57: please add reference  
Page 7, line 26: Could the authors also evaluate the other important variables including need for 
surgery, drainage (percutaneous or endoscopic). How many patients (in either group) needed 
hospital admission. It is understandable that most if not all patients in the SAP and MSAP group 
would have had admission, however, what about the MAP.   
Page 7, line 43: Kindly elaborate on the CT. What was the scann er used for image acquisition. 
Was the acquisition of entire abdomen or a limited region of abdomen done? Is CT done 
routinely within 24 hours of the admission for patients with pancreatitis in authors' institute. Are 
they routinely performing unenhanced C T for pancreatitis. Was the categorisation of local 
complications viz. APFC, ANC, WON and pseudocyst done on this CT? If not what was the 
detailed protocol for performing follow up CT scans. Why did the authors opt to choose adobe 
software for measuring th e cross -sectional area of fat and what limits of Hounsfield units did 
they select for identification of fat.  
Page 8, line 48: What was the most common etiology of pancreatitis. Did the authors note the 
proportion of patients with pancreatitis with hyperli pidemia.  
Page 9, line 28: What is MT?  
Page 10, line 3: When you refer to AP severity -are you referring to combined SAP and MSAP 
group or SAP alone. It would be of interest to rather investigate whether these cut -off give the 
same high sensitivity and spec ificity for predicting local complications particularly WOPN as 
well as the need for ICU stay and duration of hospital stay, May I request the authors to provide 
ROC curves for these parameters.  
Page 10, line 54: This recommendation is difficult to endors e as it is less likely for a patient to 
report to a tertiary care/ teaching institute within 24 hours of pain onset. Even if they report, CT 
scan within 24 hours is not justified as the other key information about the extent of pancreatic 
necrosis and loca l complications will not be obtained. The recommendation for performing a 
limited unenhanced CT at a particular level of abdomen needs to be based on a multicentre 
prospective study with randomisation.  
Page 11, line 4: Please provide references. It may be  of interest to cite few recent systematic 
reviews or meta -analysis.  
Page 11, line 20: please rephrase  
Page 11, line 23: remove repetition  
Page 11, line 29 and 31: This was not highlighted in the results section  
References 3, 5, 10, 18: cite properly  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify wh at is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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 manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess 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 declarat ion of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript,  either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 pat ents 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 competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license (http://creativecommons.org/licenses/by/4.0/ ). I understand that any co mments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant