Title: Correlation between HDL2, HDL3 and serum ferritin levels with fatty liver and NAFLD
Activity Score (NAS) in liver histology of organ donors
Version: 2 Date: 10 Jul 2021
Reviewer's report:
I have read with interest this well written manuscript by Saman Nikeghbalian, et al. This valuable
study evaluated the correlation between HDL subtypes and serum ferritin levels with evidence
of NAFLD in liver histology of organ donors. They found that lower HDL2 values and HDL2/
HDL3 ratio were associated with increased NAFLD activity score, and higher levels of ferritin in
organ donors may be associated with increased AST and ALT 24 hours after liver transplantation
in the organ recipient. I look forward to future clinical applications, however there are several
issues that need attention.
Comments:
1. I feel that the introduction is a bit redundant, so please summarize it. The explanation of
the NAFLD activity score may be more appropriate in the materials and methods section or
discussion section.
2. Please describe present key elements of study design.
3. Result section: “Serum levels of HDL2, HDL3 and ferritin were measured and recorded in
all cases. In addition, the same pathologist examined all biopsies of donated livers for NAFLD
activity score (NAS).” ##Please describe it in the method section.
4. Result section: “To investigate the relationship between serum levels of HDL2, HDL3 and
ferritin with NAS, all participants in the study were divided into two groups:
Group 1: cases with NAS #1.
Group 2: cases with NAS >1.” ##Please describe it in the method section.
In addition to the above, other contents that should be written in the method are written in the
result.
5. #Kowdley et al. found that ferritin >450 ng/ml was associated with higher levels of NAS,
AST, ALT and increased hepatic fibrosis [17].
##What is the rationale for binarizing at 1000 in this study? Also, what is the cutoff value in
this study?
6. What would be the result if the cases with possible elevated ferritin as an acute inflammatory
response are excluded?
7. How about multivariate analysis to examine factors associated with NAS>1?
8. Discuss limitations of the study, taking into account sources of potential bias or imprecision.
Title: Correlation between HDL2, HDL3 and serum ferritin levels with fatty liver and NAFLD
Activity Score (NAS) in liver histology of organ donors
Version: 2 Date: 10 Jul 2021
Reviewer's report:
I have read with interest this well written manuscript by Saman Nikeghbalian, et al. This valuable
study evaluated the correlation between HDL subtypes and serum ferritin levels with evidence
of NAFLD in liver histology of organ donors. They found that lower HDL2 values and HDL2/
HDL3 ratio were associated with increased NAFLD activity score, and higher levels of ferritin in
organ donors may be associated with increased AST and ALT 24 hours after liver transplantation
in the organ recipient. I look forward to future clinical applications, however there are several
issues that need attention.
Comments:
1. I feel that the introduction is a bit redundant, so please summarize it. The explanation of
the NAFLD activity score may be more appropriate in the materials and methods section or
discussion section.
2. Please describe present key elements of study design.
3. Result section: “Serum levels of HDL2, HDL3 and ferritin were measured and recorded in
all cases. In addition, the same pathologist examined all biopsies of donated livers for NAFLD
activity score (NAS).” ##Please describe it in the method section.
4. Result section: “To investigate the relationship between serum levels of HDL2, HDL3 and
ferritin with NAS, all participants in the study were divided into two groups:
Group 1: cases with NAS #1.
Group 2: cases with NAS >1.” ##Please describe it in the method section.
In addition to the above, other contents that should be written in the method are written in the
result.
5. #Kowdley et al. found that ferritin >450 ng/ml was associated with higher levels of NAS,
AST, ALT and increased hepatic fibrosis [17].
##What is the rationale for binarizing at 1000 in this study? Also, what is the cutoff value in
this study?
6. What would be the result if the cases with possible elevated ferritin as an acute inflammatory
response are excluded?
7. How about multivariate analysis to examine factors associated with NAS>1?
8. Discuss limitations of the study, taking into account sources of potential bias or imprecision.
Please review this paper.
user
Title: Correlation between HDL2, HDL3 and serum ferritin levels with fatty liver and NAFLD
Activity Score (NAS) in liver histology of organ donors
Version: 2 Date: 10 Jul 2021
Reviewer's report:
I have read with interest this well written manuscript by Saman Nikeghbalian, et al. This valuable
study evaluated the correlation between HDL subtypes and serum ferritin levels with evidence
of NAFLD in liver histology of organ donors. They found that lower HDL2 values and HDL2/
HDL3 ratio were associated with increased NAFLD activity score, and higher levels of ferritin in
organ donors may be associated with increased AST and ALT 24 hours after liver transplantation
in the organ recipient. I look forward to future clinical applications, however there are several
issues that need attention.
Comments:
1. I feel that the introduction is a bit redundant, so please summarize it. The explanation of
the NAFLD activity score may be more appropriate in the materials and methods section or
discussion section.
2. Please describe present key elements of study design.
3. Result section: “Serum levels of HDL2, HDL3 and ferritin were measured and recorded in
all cases. In addition, the same pathologist examined all biopsies of donated livers for NAFLD
activity score (NAS).” ##Please describe it in the method section.
4. Result section: “To investigate the relationship between serum levels of HDL2, HDL3 and
ferritin with NAS, all participants in the study were divided into two groups:
Group 1: cases with NAS #1.
Group 2: cases with NAS >1.” ##Please describe it in the method section.
In addition to the above, other contents that should be written in the method are written in the
result.
5. #Kowdley et al. found that ferritin >450 ng/ml was associated with higher levels of NAS,
AST, ALT and increased hepatic fibrosis [17].
##What is the rationale for binarizing at 1000 in this study? Also, what is the cutoff value in
this study?
6. What would be the result if the cases with possible elevated ferritin as an acute inflammatory
response are excluded?
7. How about multivariate analysis to examine factors associated with NAS>1?
8. Discuss limitations of the study, taking into account sources of potential bias or imprecision.
assistant