Title: Association of FIB-4 Index and Clinical Outcomes in Critically ill Patients with Acute
Kidney Injury: A Cohort Study
Version: 2 Date: 03 Nov 2021
Reviewer's report:
1. According to the responses, the authors claim that they just want to evaluate “only correlation”
between FIB-4 and mortality. The authors thought that the most important thing for correlation
analysis is to prove the correlation between FIB-4 index and all-cause mortality. They refused
to answer the question which is more practical: did the FIB-4 could help identify who are at
risk of death? However, the authors still concluded that “Therefore, FIB-4 index may serve
as a noninvasive simple-to-use markers to identify patient at high risk of death in the AKI
population.” (Discussion, 1st paragraph) If the authors do not think predicting mortality by FIB-4
is an important thing, how could the results be applied in clinical practice?
2. The authors claim that “However, OR or HR value is not the most important, it does not
affect our conclusion of this article that FIB-4 is associated with clinical outcomes in critically
ill patients with acute kidney injury.” I agree with the authors that the conclusion of correlation
between FIB-4 and the clinical outcome did not change. However, not only the statistical
significance but also the effect size are important. I disagreed with the authors' viewpoint
that whether the correlation was statistically significant is the most important. The effect size,
representing whether the findings are clinically important or not, is also a critical issue.
3. The authors did not want to compare the performances between models. I respect their
decision. However, the current model does not contain age, which is one of the most important
factors associated with death. The authors should show the effect sizes (OR/OR) of both FIB-4
and age for patient prognosis. At least, replace the FIB-4 with age in the regression model and
report the effect size (OR/HR) of age. This could roughly tell us whether FIB-4 is better than
just age to identify the patient at high risk of death.
Title: Association of FIB-4 Index and Clinical Outcomes in Critically ill Patients with Acute
Kidney Injury: A Cohort Study
Version: 2 Date: 03 Nov 2021
Reviewer's report:
1. According to the responses, the authors claim that they just want to evaluate “only correlation”
between FIB-4 and mortality. The authors thought that the most important thing for correlation
analysis is to prove the correlation between FIB-4 index and all-cause mortality. They refused
to answer the question which is more practical: did the FIB-4 could help identify who are at
risk of death? However, the authors still concluded that “Therefore, FIB-4 index may serve
as a noninvasive simple-to-use markers to identify patient at high risk of death in the AKI
population.” (Discussion, 1st paragraph) If the authors do not think predicting mortality by FIB-4
is an important thing, how could the results be applied in clinical practice?
2. The authors claim that “However, OR or HR value is not the most important, it does not
affect our conclusion of this article that FIB-4 is associated with clinical outcomes in critically
ill patients with acute kidney injury.” I agree with the authors that the conclusion of correlation
between FIB-4 and the clinical outcome did not change. However, not only the statistical
significance but also the effect size are important. I disagreed with the authors' viewpoint
that whether the correlation was statistically significant is the most important. The effect size,
representing whether the findings are clinically important or not, is also a critical issue.
3. The authors did not want to compare the performances between models. I respect their
decision. However, the current model does not contain age, which is one of the most important
factors associated with death. The authors should show the effect sizes (OR/OR) of both FIB-4
and age for patient prognosis. At least, replace the FIB-4 with age in the regression model and
report the effect size (OR/HR) of age. This could roughly tell us whether FIB-4 is better than
just age to identify the patient at high risk of death.
Please review this paper.
user
Title: Association of FIB-4 Index and Clinical Outcomes in Critically ill Patients with Acute
Kidney Injury: A Cohort Study
Version: 2 Date: 03 Nov 2021
Reviewer's report:
1. According to the responses, the authors claim that they just want to evaluate “only correlation”
between FIB-4 and mortality. The authors thought that the most important thing for correlation
analysis is to prove the correlation between FIB-4 index and all-cause mortality. They refused
to answer the question which is more practical: did the FIB-4 could help identify who are at
risk of death? However, the authors still concluded that “Therefore, FIB-4 index may serve
as a noninvasive simple-to-use markers to identify patient at high risk of death in the AKI
population.” (Discussion, 1st paragraph) If the authors do not think predicting mortality by FIB-4
is an important thing, how could the results be applied in clinical practice?
2. The authors claim that “However, OR or HR value is not the most important, it does not
affect our conclusion of this article that FIB-4 is associated with clinical outcomes in critically
ill patients with acute kidney injury.” I agree with the authors that the conclusion of correlation
between FIB-4 and the clinical outcome did not change. However, not only the statistical
significance but also the effect size are important. I disagreed with the authors' viewpoint
that whether the correlation was statistically significant is the most important. The effect size,
representing whether the findings are clinically important or not, is also a critical issue.
3. The authors did not want to compare the performances between models. I respect their
decision. However, the current model does not contain age, which is one of the most important
factors associated with death. The authors should show the effect sizes (OR/OR) of both FIB-4
and age for patient prognosis. At least, replace the FIB-4 with age in the regression model and
report the effect size (OR/HR) of age. This could roughly tell us whether FIB-4 is better than
just age to identify the patient at high risk of death.
assistant