Title: Diagnostic performance of a new algorithm combining simple, non-invasive and
inexpensive tests for predicting the presence of advanced liver fibrosis in patients with chronic
hepatitis B.
Version: 5 Date: 03 Dec 2024
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 (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
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?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
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?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Overall, it is a scientifically valid study. The authors have devised a
novel algorithm for non-invasive assessment of liver fibrosis. Its presentation and interpretation
are poor. The latter need major revisions.
REQUESTED REVISIONS:
They need to work hard to simplify its results, cut-offs, interpretation with the help of a
professional editing agency or a biomedical statistician.
ADDITIONAL REQUESTS/SUGGESTIONS:
This is a partially revised manuscript in response to earlier review by another reviewer. The
manuscript has improved but there are still some issues with its presentation and English
language.
Overall, in this study, the authors evaluated the diagnostic performance of a diagnostic algorithm
based on simple, inexpensive and non-invasive tests routinely performed in any hospital. They
presented the results in both a training group and a validation group in a multicenter study
involving a fairly large sample size of chronic hepatitis B infection. They concluded that a new
algorithm combining simple, non-invasive and inexpensive tests has a better diagnostic value
than usual scores in predicting severe #brosis in patients with chronic hepatitis B.
This is an important study with significant clinical implications. If it can be validated in other
settings and other racial groups, it can serve as a useful, inexpensive, and simple tool for non-
invasive detection of liver fibrosis or lack thereof. There are no ethical issues. Written informed
consent was obtained from patients and ethical approval was sought from the relevant hospitals.
It is well designed and well conducted. The quality of scientific research work is fine.
However, its presentation and interpretation need major revisions. I would suggest its
professional editing by a professional editing company or some senior English speaking
colleague and a biomedical statistician. English also needs careful consideration throughout the
manuscript."
Title: Diagnostic performance of a new algorithm combining simple, non-invasive and
inexpensive tests for predicting the presence of advanced liver fibrosis in patients with chronic
hepatitis B.
Version: 5 Date: 03 Dec 2024
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 (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
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?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
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?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Overall, it is a scientifically valid study. The authors have devised a
novel algorithm for non-invasive assessment of liver fibrosis. Its presentation and interpretation
are poor. The latter need major revisions.
REQUESTED REVISIONS:
They need to work hard to simplify its results, cut-offs, interpretation with the help of a
professional editing agency or a biomedical statistician.
ADDITIONAL REQUESTS/SUGGESTIONS:
This is a partially revised manuscript in response to earlier review by another reviewer. The
manuscript has improved but there are still some issues with its presentation and English
language.
Overall, in this study, the authors evaluated the diagnostic performance of a diagnostic algorithm
based on simple, inexpensive and non-invasive tests routinely performed in any hospital. They
presented the results in both a training group and a validation group in a multicenter study
involving a fairly large sample size of chronic hepatitis B infection. They concluded that a new
algorithm combining simple, non-invasive and inexpensive tests has a better diagnostic value
than usual scores in predicting severe #brosis in patients with chronic hepatitis B.
This is an important study with significant clinical implications. If it can be validated in other
settings and other racial groups, it can serve as a useful, inexpensive, and simple tool for non-
invasive detection of liver fibrosis or lack thereof. There are no ethical issues. Written informed
consent was obtained from patients and ethical approval was sought from the relevant hospitals.
It is well designed and well conducted. The quality of scientific research work is fine.
However, its presentation and interpretation need major revisions. I would suggest its
professional editing by a professional editing company or some senior English speaking
colleague and a biomedical statistician. English also needs careful consideration throughout the
manuscript."
Please review this paper.
user
Title: Diagnostic performance of a new algorithm combining simple, non-invasive and
inexpensive tests for predicting the presence of advanced liver fibrosis in patients with chronic
hepatitis B.
Version: 5 Date: 03 Dec 2024
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 (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
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?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
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?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Overall, it is a scientifically valid study. The authors have devised a
novel algorithm for non-invasive assessment of liver fibrosis. Its presentation and interpretation
are poor. The latter need major revisions.
REQUESTED REVISIONS:
They need to work hard to simplify its results, cut-offs, interpretation with the help of a
professional editing agency or a biomedical statistician.
ADDITIONAL REQUESTS/SUGGESTIONS:
This is a partially revised manuscript in response to earlier review by another reviewer. The
manuscript has improved but there are still some issues with its presentation and English
language.
Overall, in this study, the authors evaluated the diagnostic performance of a diagnostic algorithm
based on simple, inexpensive and non-invasive tests routinely performed in any hospital. They
presented the results in both a training group and a validation group in a multicenter study
involving a fairly large sample size of chronic hepatitis B infection. They concluded that a new
algorithm combining simple, non-invasive and inexpensive tests has a better diagnostic value
than usual scores in predicting severe #brosis in patients with chronic hepatitis B.
This is an important study with significant clinical implications. If it can be validated in other
settings and other racial groups, it can serve as a useful, inexpensive, and simple tool for non-
invasive detection of liver fibrosis or lack thereof. There are no ethical issues. Written informed
consent was obtained from patients and ethical approval was sought from the relevant hospitals.
It is well designed and well conducted. The quality of scientific research work is fine.
However, its presentation and interpretation need major revisions. I would suggest its
professional editing by a professional editing company or some senior English speaking
colleague and a biomedical statistician. English also needs careful consideration throughout the
manuscript."
assistant