Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 12 May 2020
Reviewer: Gabriele Spoletini
Reviewer's report:
The Authors report on a cross-sectional study comparing the performance of conventional
coagulation tests with thromboelastography in ACLF and non-ACLF patients. As cirrhotics canexperience erratic coagulation conditions which are not entirely captured by CCTs, ROTEM hasalready been shown to provide a more thorough picture of their clotting status.The manuscript is well-written and reads smoothly.I see there has been an integration regarding the correlation between bleeding events and ROTEMresults, which I think is interesting.Weakness of the work is limited novelty as the topic has been explored already. However, I think itstill adds some knowledge to the field.
My observations regarding the work are:
1.Methods in Abstract should include a concise explanation of how the work intends to addressthe primary objective of the study.2.Line 214: "more frequently that CCT" should be "than".3.When was ROTEM performed? This should be specified even if no specific time of testperformance was contemplated in the study. I read "Clinical and laboratory data were collected
within 24 hours of admission". Does this include ROTEM?
4.Lines 311-313: "Based on our results, one can speculate that particularly in the ACLF patients -with a high frequency of pathological coagulation based on CCT -transfusion regimens based onROTEM could lead to much lower transfusion requirements". I can grab the concept (i.e.,transfusion policy can be guided by ROTEM results instead of using CCT) but this should beprobably rephrased.5.Line 321 "as prognostic important factors" should be "as important prognostic factors"6.Supposedly, almost all ACLF admissions were emergency. It would interesting to know howmany elective admissions there were in the Non-ACLF group (I see a relevant proportion ofpatients were admitted for TACE, therefore coming from home in an expectedly balanced clinicalstatus) and how many had acute decompensation.7.I would expand a little on Limitations of the work and explain what the work adds compared toprevious articles on the same topic.
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.
YesAre 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 manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 financially 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 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
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.
Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 12 May 2020
Reviewer: Gabriele Spoletini
Reviewer's report:
The Authors report on a cross-sectional study comparing the performance of conventional
coagulation tests with thromboelastography in ACLF and non-ACLF patients. As cirrhotics canexperience erratic coagulation conditions which are not entirely captured by CCTs, ROTEM hasalready been shown to provide a more thorough picture of their clotting status.The manuscript is well-written and reads smoothly.I see there has been an integration regarding the correlation between bleeding events and ROTEMresults, which I think is interesting.Weakness of the work is limited novelty as the topic has been explored already. However, I think itstill adds some knowledge to the field.
My observations regarding the work are:
1.Methods in Abstract should include a concise explanation of how the work intends to addressthe primary objective of the study.2.Line 214: "more frequently that CCT" should be "than".3.When was ROTEM performed? This should be specified even if no specific time of testperformance was contemplated in the study. I read "Clinical and laboratory data were collected
within 24 hours of admission". Does this include ROTEM?
4.Lines 311-313: "Based on our results, one can speculate that particularly in the ACLF patients -with a high frequency of pathological coagulation based on CCT -transfusion regimens based onROTEM could lead to much lower transfusion requirements". I can grab the concept (i.e.,transfusion policy can be guided by ROTEM results instead of using CCT) but this should beprobably rephrased.5.Line 321 "as prognostic important factors" should be "as important prognostic factors"6.Supposedly, almost all ACLF admissions were emergency. It would interesting to know howmany elective admissions there were in the Non-ACLF group (I see a relevant proportion ofpatients were admitted for TACE, therefore coming from home in an expectedly balanced clinicalstatus) and how many had acute decompensation.7.I would expand a little on Limitations of the work and explain what the work adds compared toprevious articles on the same topic.
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.
YesAre 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 manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 financially 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 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
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.
Please review this paper.
user
Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 12 May 2020
Reviewer: Gabriele Spoletini
Reviewer's report:
The Authors report on a cross-sectional study comparing the performance of conventional
coagulation tests with thromboelastography in ACLF and non-ACLF patients. As cirrhotics canexperience erratic coagulation conditions which are not entirely captured by CCTs, ROTEM hasalready been shown to provide a more thorough picture of their clotting status.The manuscript is well-written and reads smoothly.I see there has been an integration regarding the correlation between bleeding events and ROTEMresults, which I think is interesting.Weakness of the work is limited novelty as the topic has been explored already. However, I think itstill adds some knowledge to the field.
My observations regarding the work are:
1.Methods in Abstract should include a concise explanation of how the work intends to addressthe primary objective of the study.2.Line 214: "more frequently that CCT" should be "than".3.When was ROTEM performed? This should be specified even if no specific time of testperformance was contemplated in the study. I read "Clinical and laboratory data were collected
within 24 hours of admission". Does this include ROTEM?
4.Lines 311-313: "Based on our results, one can speculate that particularly in the ACLF patients -with a high frequency of pathological coagulation based on CCT -transfusion regimens based onROTEM could lead to much lower transfusion requirements". I can grab the concept (i.e.,transfusion policy can be guided by ROTEM results instead of using CCT) but this should beprobably rephrased.5.Line 321 "as prognostic important factors" should be "as important prognostic factors"6.Supposedly, almost all ACLF admissions were emergency. It would interesting to know howmany elective admissions there were in the Non-ACLF group (I see a relevant proportion ofpatients were admitted for TACE, therefore coming from home in an expectedly balanced clinicalstatus) and how many had acute decompensation.7.I would expand a little on Limitations of the work and explain what the work adds compared toprevious articles on the same topic.
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.
YesAre 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 manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 financially 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 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
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.
assistant