Reviewer ’s report  
 
Title: Initially Elevated Arterial Lactate as an Independent Predi ctor of Poor Outcomes in Severe 
Acute Pancreatitis  
 
Version: 2 Date: 22 Jan 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question (s) (brief or other article types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
No - there are major issues  
 
 
EXECUTION - Are the e xperiments and analyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
No - there are issues with the statistics in the study  
 
 
INTERPRETAT ION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are minor issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work t echnically sound?  
 
Maybe - with major revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
 
This is a retrospective study evaluating arterial lactate levels in defining the risk of acute 
pancreatitis.  
 
The results are written well.  
 
I think it would be better if pH, pO2 and pCO2 levels were also included in this study. Since they 
may also be correlating with outcome as well as lactate levels.  
 
I also have following comments.  
 
 
Is 'absolute value of base excess' correlated with lactate  levels? So it may be inappropriate to 
compare this level.  
 
One of the outcomes is defined as peripancreatic infection, however on the other hand one of the 
diagnostic criteria is also an infection, namely "positive Gram stain and culture for bacteria 
and/or fungi". Please define if this is a conflicting definition.  
 
In statistical analysis some sentences are in future tense, revise it to define whether it is done or 
not. 
 
Which test is used for comparing the repeated measures (admission vs seven day).  
 
Instead of using "meaningful differences" use "statistically significant difference" or "clinically 
important difference" based on the emphasis you want to make.  
 
Page 5 line 33: correct the sentence including "mean difference"  
 
For Table 2: The groups are ov erlapping. So the comparison with chi -square test may not be 
appropriate. Please consult a statistican.  
 
For Table 3: The numbers are low. Please define if Fisher exact test are used or not.  
 
For Figure 3: I recommend repeated measures ANOVA test to be use d for this data.  
 
 
REQUESTED REVISIONS:  
 
For design: I would recommend other arterial serum levels, namely pO2, pH, pCO2.  
 
For execution and statistics: There are issues I have written in question 2. A repeated measures 
test is recommended.  
Are the methods appropriate and well described?  
If not, please specify what 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess a ny 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 assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering 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 you hold any stocks or shar es 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 rec eived 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 interest s 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.  
 
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 Creat ive Commons Attribution License 
attributed to Research Square and was paid a s mall honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
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 f or 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 Ope n Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
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: Initially Elevated Arterial Lactate as an Independent Predi ctor of Poor Outcomes in Severe 
Acute Pancreatitis  
 
Version: 2 Date: 22 Jan 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question (s) (brief or other article types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
No - there are major issues  
 
 
EXECUTION - Are the e xperiments and analyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
No - there are issues with the statistics in the study  
 
 
INTERPRETAT ION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are minor issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work t echnically sound?  
 
Maybe - with major revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
 
This is a retrospective study evaluating arterial lactate levels in defining the risk of acute 
pancreatitis.  
 
The results are written well.  
 
I think it would be better if pH, pO2 and pCO2 levels were also included in this study. Since they 
may also be correlating with outcome as well as lactate levels.  
 
I also have following comments.  
 
 
Is 'absolute value of base excess' correlated with lactate  levels? So it may be inappropriate to 
compare this level.  
 
One of the outcomes is defined as peripancreatic infection, however on the other hand one of the 
diagnostic criteria is also an infection, namely "positive Gram stain and culture for bacteria 
and/or fungi". Please define if this is a conflicting definition.  
 
In statistical analysis some sentences are in future tense, revise it to define whether it is done or 
not. 
 
Which test is used for comparing the repeated measures (admission vs seven day).  
 
Instead of using "meaningful differences" use "statistically significant difference" or "clinically 
important difference" based on the emphasis you want to make.  
 
Page 5 line 33: correct the sentence including "mean difference"  
 
For Table 2: The groups are ov erlapping. So the comparison with chi -square test may not be 
appropriate. Please consult a statistican.  
 
For Table 3: The numbers are low. Please define if Fisher exact test are used or not.  
 
For Figure 3: I recommend repeated measures ANOVA test to be use d for this data.  
 
 
REQUESTED REVISIONS:  
 
For design: I would recommend other arterial serum levels, namely pO2, pH, pCO2.  
 
For execution and statistics: There are issues I have written in question 2. A repeated measures 
test is recommended.  
Are the methods appropriate and well described?  
If not, please specify what 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess a ny 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 assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering 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 you hold any stocks or shar es 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 rec eived 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 interest s 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.  
 
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 Creat ive Commons Attribution License 
attributed to Research Square and was paid a s mall honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
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 f or 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 Ope n Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
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: Initially Elevated Arterial Lactate as an Independent Predi ctor of Poor Outcomes in Severe 
Acute Pancreatitis  
 
Version: 2 Date: 22 Jan 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question (s) (brief or other article types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
No - there are major issues  
 
 
EXECUTION - Are the e xperiments and analyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
No - there are issues with the statistics in the study  
 
 
INTERPRETAT ION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are minor issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work t echnically sound?  
 
Maybe - with major revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
 
This is a retrospective study evaluating arterial lactate levels in defining the risk of acute 
pancreatitis.  
 
The results are written well.  
 
I think it would be better if pH, pO2 and pCO2 levels were also included in this study. Since they 
may also be correlating with outcome as well as lactate levels.  
 
I also have following comments.  
 
 
Is 'absolute value of base excess' correlated with lactate  levels? So it may be inappropriate to 
compare this level.  
 
One of the outcomes is defined as peripancreatic infection, however on the other hand one of the 
diagnostic criteria is also an infection, namely "positive Gram stain and culture for bacteria 
and/or fungi". Please define if this is a conflicting definition.  
 
In statistical analysis some sentences are in future tense, revise it to define whether it is done or 
not. 
 
Which test is used for comparing the repeated measures (admission vs seven day).  
 
Instead of using "meaningful differences" use "statistically significant difference" or "clinically 
important difference" based on the emphasis you want to make.  
 
Page 5 line 33: correct the sentence including "mean difference"  
 
For Table 2: The groups are ov erlapping. So the comparison with chi -square test may not be 
appropriate. Please consult a statistican.  
 
For Table 3: The numbers are low. Please define if Fisher exact test are used or not.  
 
For Figure 3: I recommend repeated measures ANOVA test to be use d for this data.  
 
 
REQUESTED REVISIONS:  
 
For design: I would recommend other arterial serum levels, namely pO2, pH, pCO2.  
 
For execution and statistics: There are issues I have written in question 2. A repeated measures 
test is recommended.  
Are the methods appropriate and well described?  
If not, please specify what 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess a ny 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 assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering 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 you hold any stocks or shar es 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 rec eived 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 interest s 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.  
 
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 Creat ive Commons Attribution License 
attributed to Research Square and was paid a s mall honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
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 f or 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 Ope n Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
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