Reviewer ’s report  
 
Title: The incidence, etiolog ies, outcomes, and predictors of mort ality of acute liver failure in 
Thailand: a population -base study  
 
Version: 0 Date: 04 Jul 2018  
 
Reviewer: Xiaogang Xiang  
 
Reviewer's report:  
 
In this paper, the authors retrospectively analyzed th e characteristic of acute liver failure (ALF) 
in Thailand with a sample of 20,589 patients. They found that the incidence rate of ALF was 
62.9 per million population per year with a 30 -day mortality rate of 26.7%. The most frequent 
causes of ALF were indet erminate (68.4%), and the main predictors of 30 -day mortality are 
ventilator support, malignant infiltration of liver, and ARF. The sample size in this study is 
sufficient, and the data can support the conclusion.  
 
 
Major points:  
 
1. The diagnostic criteria of ALF should be mentioned in the Methods. As all the patients 
selected in the study were selected from different levels of hospitals, it is extremely 
important to make sure all the patients diagnosed according to the same criteria.  
 
 
2. It's well known tha t MELD score is widely used for predicting the mortality of end -stage 
liver diseases. How is the difference of the MELD scores between survived and died 
patients at admission?  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
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 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 quali ty 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 rei mbursements, 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 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 patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary fr om 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publicati on, my named report 
including any attachments I upload will be posted on the websi te 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 comments 
which I do not wish to be included in my name d report can be in cluded 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: The incidence, etiolog ies, outcomes, and predictors of mort ality of acute liver failure in 
Thailand: a population -base study  
 
Version: 0 Date: 04 Jul 2018  
 
Reviewer: Xiaogang Xiang  
 
Reviewer's report:  
 
In this paper, the authors retrospectively analyzed th e characteristic of acute liver failure (ALF) 
in Thailand with a sample of 20,589 patients. They found that the incidence rate of ALF was 
62.9 per million population per year with a 30 -day mortality rate of 26.7%. The most frequent 
causes of ALF were indet erminate (68.4%), and the main predictors of 30 -day mortality are 
ventilator support, malignant infiltration of liver, and ARF. The sample size in this study is 
sufficient, and the data can support the conclusion.  
 
 
Major points:  
 
1. The diagnostic criteria of ALF should be mentioned in the Methods. As all the patients 
selected in the study were selected from different levels of hospitals, it is extremely 
important to make sure all the patients diagnosed according to the same criteria.  
 
 
2. It's well known tha t MELD score is widely used for predicting the mortality of end -stage 
liver diseases. How is the difference of the MELD scores between survived and died 
patients at admission?  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
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 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 quali ty 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 rei mbursements, 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 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 patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary fr om 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publicati on, my named report 
including any attachments I upload will be posted on the websi te 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 comments 
which I do not wish to be included in my name d report can be in cluded 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: The incidence, etiolog ies, outcomes, and predictors of mort ality of acute liver failure in 
Thailand: a population -base study  
 
Version: 0 Date: 04 Jul 2018  
 
Reviewer: Xiaogang Xiang  
 
Reviewer's report:  
 
In this paper, the authors retrospectively analyzed th e characteristic of acute liver failure (ALF) 
in Thailand with a sample of 20,589 patients. They found that the incidence rate of ALF was 
62.9 per million population per year with a 30 -day mortality rate of 26.7%. The most frequent 
causes of ALF were indet erminate (68.4%), and the main predictors of 30 -day mortality are 
ventilator support, malignant infiltration of liver, and ARF. The sample size in this study is 
sufficient, and the data can support the conclusion.  
 
 
Major points:  
 
1. The diagnostic criteria of ALF should be mentioned in the Methods. As all the patients 
selected in the study were selected from different levels of hospitals, it is extremely 
important to make sure all the patients diagnosed according to the same criteria.  
 
 
2. It's well known tha t MELD score is widely used for predicting the mortality of end -stage 
liver diseases. How is the difference of the MELD scores between survived and died 
patients at admission?  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
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 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 quali ty 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 rei mbursements, 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 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 patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary fr om 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publicati on, my named report 
including any attachments I upload will be posted on the websi te 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 comments 
which I do not wish to be included in my name d report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant