Reviewer ’s report  
 
Title: High -density lipoprotein cholesterol to low -density lipopro tein cholesterol ratio in early 
assessment of disease severity and outcome in patients with acute pancreatitis admitted to the 
ICU 
 
Version: 1 Date: 28 Mar 2020  
 
Reviewer's report:  
 
This is an interested and well designed study aimed to explore the significance of HDL -C/LDL -
C ratio for prognosis of acute pancreatitis outcome. My comments are following:  
 
 
Introduction  
 
"Most of the previous studies have focused on hypertriglyceridemia, as this is a risk factor for the 
accumulation of free fatty acid s in pancreatic lipases hydrolyzed in the pancreases of patients 
with AP. "  
 
This sentence needs correction, since it's unclear what the authors wanted to emphasize.  
 
 
Results  
 
ROC (AUC) analysis was interpreted as a measure of predictive abilities of variables for 
mortality. However, ROC analysis is used for estimation of diagnostic performances 
(discrimination between clinical conditions) of clinical tests and not for estimatio n of its 
predictive capacity.  
 
 
Discussion  
 
"Rather than measuring actual HDL and LDL particles, assessing HDL -C and LDL -C levels 
provides information about how much cholesterol is delivered by all HDL and LDL particles and 
when they invade the endothelium a nd are oxidized."  
 
Actually, measuring of HDL -C and LDL -C does not provide information on endothelial invasion 
and oxidation. LDL and HDL subclasses determination, as well as measuring of oxidized LDL 
and HDL are necessary for these purposes. Please correct . 
 
"The method most commonly used to measure HDL -C and LDL -C is the Friedewald equation"  
 
Friedwald equation is being used for estimation of LDL -C, but not HDL -C levels. Please correct.  
 
"Recently, several studies with small sample sizes reported that low levels of HDL -C are 
associated with high risk of persistent organ failure in AP [22]. Our study confirmed that HDL -C 
levels could be a predictor for patients with AP, which is consistent with other studies [23, 24]. 
However, we found that the H/L ratio had  a better predictive value than HDL -C levels."  
 
However, in this study higher H/L values were found in non -survivors. This result needs further 
explanation, since it suggests that lower HDL -C is beneficial for patients, which is inconsistent 
with previous f indings. Furthermore, I suggest checking data distribution for lipid status 
parameters. Namely, standard deviations are rather high and for H/L ratio standard deviation is 
even higher than mean. It is likely that median (interquartile range) and Mann -Whitn ey U test 
would be more representative for this data set. Moreover, concentration of TG should be 
presented too. The authors reported cases of hyperlipidemia (20%), but the presented mean 
values for TC, LDL -C and HDL -C are not indicative for hyperlipidemia , instead the values are 
rather low. This should be clarified.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work inclu de 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 asses s 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, fees, 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 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 re ceived 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 understan d that m y 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 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 named 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: High -density lipoprotein cholesterol to low -density lipopro tein cholesterol ratio in early 
assessment of disease severity and outcome in patients with acute pancreatitis admitted to the 
ICU 
 
Version: 1 Date: 28 Mar 2020  
 
Reviewer's report:  
 
This is an interested and well designed study aimed to explore the significance of HDL -C/LDL -
C ratio for prognosis of acute pancreatitis outcome. My comments are following:  
 
 
Introduction  
 
"Most of the previous studies have focused on hypertriglyceridemia, as this is a risk factor for the 
accumulation of free fatty acid s in pancreatic lipases hydrolyzed in the pancreases of patients 
with AP. "  
 
This sentence needs correction, since it's unclear what the authors wanted to emphasize.  
 
 
Results  
 
ROC (AUC) analysis was interpreted as a measure of predictive abilities of variables for 
mortality. However, ROC analysis is used for estimation of diagnostic performances 
(discrimination between clinical conditions) of clinical tests and not for estimatio n of its 
predictive capacity.  
 
 
Discussion  
 
"Rather than measuring actual HDL and LDL particles, assessing HDL -C and LDL -C levels 
provides information about how much cholesterol is delivered by all HDL and LDL particles and 
when they invade the endothelium a nd are oxidized."  
 
Actually, measuring of HDL -C and LDL -C does not provide information on endothelial invasion 
and oxidation. LDL and HDL subclasses determination, as well as measuring of oxidized LDL 
and HDL are necessary for these purposes. Please correct . 
 
"The method most commonly used to measure HDL -C and LDL -C is the Friedewald equation"  
 
Friedwald equation is being used for estimation of LDL -C, but not HDL -C levels. Please correct.  
 
"Recently, several studies with small sample sizes reported that low levels of HDL -C are 
associated with high risk of persistent organ failure in AP [22]. Our study confirmed that HDL -C 
levels could be a predictor for patients with AP, which is consistent with other studies [23, 24]. 
However, we found that the H/L ratio had  a better predictive value than HDL -C levels."  
 
However, in this study higher H/L values were found in non -survivors. This result needs further 
explanation, since it suggests that lower HDL -C is beneficial for patients, which is inconsistent 
with previous f indings. Furthermore, I suggest checking data distribution for lipid status 
parameters. Namely, standard deviations are rather high and for H/L ratio standard deviation is 
even higher than mean. It is likely that median (interquartile range) and Mann -Whitn ey U test 
would be more representative for this data set. Moreover, concentration of TG should be 
presented too. The authors reported cases of hyperlipidemia (20%), but the presented mean 
values for TC, LDL -C and HDL -C are not indicative for hyperlipidemia , instead the values are 
rather low. This should be clarified.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work inclu de 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 asses s 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, fees, 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 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 re ceived 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 understan d that m y 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 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 named 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: High -density lipoprotein cholesterol to low -density lipopro tein cholesterol ratio in early 
assessment of disease severity and outcome in patients with acute pancreatitis admitted to the 
ICU 
 
Version: 1 Date: 28 Mar 2020  
 
Reviewer's report:  
 
This is an interested and well designed study aimed to explore the significance of HDL -C/LDL -
C ratio for prognosis of acute pancreatitis outcome. My comments are following:  
 
 
Introduction  
 
"Most of the previous studies have focused on hypertriglyceridemia, as this is a risk factor for the 
accumulation of free fatty acid s in pancreatic lipases hydrolyzed in the pancreases of patients 
with AP. "  
 
This sentence needs correction, since it's unclear what the authors wanted to emphasize.  
 
 
Results  
 
ROC (AUC) analysis was interpreted as a measure of predictive abilities of variables for 
mortality. However, ROC analysis is used for estimation of diagnostic performances 
(discrimination between clinical conditions) of clinical tests and not for estimatio n of its 
predictive capacity.  
 
 
Discussion  
 
"Rather than measuring actual HDL and LDL particles, assessing HDL -C and LDL -C levels 
provides information about how much cholesterol is delivered by all HDL and LDL particles and 
when they invade the endothelium a nd are oxidized."  
 
Actually, measuring of HDL -C and LDL -C does not provide information on endothelial invasion 
and oxidation. LDL and HDL subclasses determination, as well as measuring of oxidized LDL 
and HDL are necessary for these purposes. Please correct . 
 
"The method most commonly used to measure HDL -C and LDL -C is the Friedewald equation"  
 
Friedwald equation is being used for estimation of LDL -C, but not HDL -C levels. Please correct.  
 
"Recently, several studies with small sample sizes reported that low levels of HDL -C are 
associated with high risk of persistent organ failure in AP [22]. Our study confirmed that HDL -C 
levels could be a predictor for patients with AP, which is consistent with other studies [23, 24]. 
However, we found that the H/L ratio had  a better predictive value than HDL -C levels."  
 
However, in this study higher H/L values were found in non -survivors. This result needs further 
explanation, since it suggests that lower HDL -C is beneficial for patients, which is inconsistent 
with previous f indings. Furthermore, I suggest checking data distribution for lipid status 
parameters. Namely, standard deviations are rather high and for H/L ratio standard deviation is 
even higher than mean. It is likely that median (interquartile range) and Mann -Whitn ey U test 
would be more representative for this data set. Moreover, concentration of TG should be 
presented too. The authors reported cases of hyperlipidemia (20%), but the presented mean 
values for TC, LDL -C and HDL -C are not indicative for hyperlipidemia , instead the values are 
rather low. This should be clarified.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work inclu de 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 asses s 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, fees, 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 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 re ceived 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 understan d that m y 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 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 named 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