Reviewer ’s report  
 
Title: Macrocytic anemia is associated with the severity of li ver impairment in patients with 
hepatitis B virus -related decompensated cirrhosis: a retrospective cross -sectional study  
 
Version: 0 Date: 08 Jul 2018  
 
Reviewer: Sei Kakinuma  
 
Reviewer's report:  
 
This is a manuscript describing that macrocytic anemia is associated with MELD score in HBV -
related decompensated LC. Authors showed several data that macrocytic anemia is associated 
with MELD score in HBV -related decompensated LC, ho wever, clinical significance of this 
study is unclear, because MELD score can already predict the prognosis of LC -patients. 
Moreover, the pathophysiology that macrocytic anemia is associated with MELD score, which 
was described in this study, was also uncl ear. There are several technical problems in this study.  
 
 
 
Specific points:  
 
#1. Clinical significance of this study is unclear, because MELD score can already predict the 
prognosis of LC -patients. Authors should show why the association between mean corpus cular 
volume (MCV) and MELD score is essential for the management of LC patients. Moreover, the 
most important factor associated with MELD score was cholesterol (OR -2.53, Table 2) in this 
study.  
 
 
#2. Why the authors analyzed the association between MCV a nd MELD score alone. How about 
the Child -Pugh score, or other scale? The pathophysiology that macrocytic anemia is associated 
with MELD score, which was described in this study, was also unclear.  
 
 
#3. In Table 1, MCV seems to be clearly correlated with age  of patients. Thus, it is possible that 
MCV is associated with MELD score (poor prognosis) via correlation with age. Authors should 
re-analyze the association of such factors using propensity score matching methods.  
 
 
#4. In Table 2, microscopic anemia was  not significant in univariate analysis. Why did the 
authors analyze "microscopic anemia" in multivariate analysis?  
 
 
 
 
 
Minor points  
 
There are several simple errors in this manuscript.  
 
#1. In Table 1, number or the % of drinking in normocytic group was wrong.  
 
#2. There are grammatical errors in this manuscript, and it should be edited by native speakers.  
 
 
 
Are the methods appropriate and well described?  
If not, please spe cify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
 
 
 
 
 
 
 
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 fro m 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 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 received reimbursements, fees, funding, or salary from an organization that 
holds or has appl ied 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 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 editor s, which will not be publis hed. 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Macrocytic anemia is associated with the severity of li ver impairment in patients with 
hepatitis B virus -related decompensated cirrhosis: a retrospective cross -sectional study  
 
Version: 0 Date: 08 Jul 2018  
 
Reviewer: Sei Kakinuma  
 
Reviewer's report:  
 
This is a manuscript describing that macrocytic anemia is associated with MELD score in HBV -
related decompensated LC. Authors showed several data that macrocytic anemia is associated 
with MELD score in HBV -related decompensated LC, ho wever, clinical significance of this 
study is unclear, because MELD score can already predict the prognosis of LC -patients. 
Moreover, the pathophysiology that macrocytic anemia is associated with MELD score, which 
was described in this study, was also uncl ear. There are several technical problems in this study.  
 
 
 
Specific points:  
 
#1. Clinical significance of this study is unclear, because MELD score can already predict the 
prognosis of LC -patients. Authors should show why the association between mean corpus cular 
volume (MCV) and MELD score is essential for the management of LC patients. Moreover, the 
most important factor associated with MELD score was cholesterol (OR -2.53, Table 2) in this 
study.  
 
 
#2. Why the authors analyzed the association between MCV a nd MELD score alone. How about 
the Child -Pugh score, or other scale? The pathophysiology that macrocytic anemia is associated 
with MELD score, which was described in this study, was also unclear.  
 
 
#3. In Table 1, MCV seems to be clearly correlated with age  of patients. Thus, it is possible that 
MCV is associated with MELD score (poor prognosis) via correlation with age. Authors should 
re-analyze the association of such factors using propensity score matching methods.  
 
 
#4. In Table 2, microscopic anemia was  not significant in univariate analysis. Why did the 
authors analyze "microscopic anemia" in multivariate analysis?  
 
 
 
 
 
Minor points  
 
There are several simple errors in this manuscript.  
 
#1. In Table 1, number or the % of drinking in normocytic group was wrong.  
 
#2. There are grammatical errors in this manuscript, and it should be edited by native speakers.  
 
 
 
Are the methods appropriate and well described?  
If not, please spe cify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
 
 
 
 
 
 
 
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 fro m 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 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 received reimbursements, fees, funding, or salary from an organization that 
holds or has appl ied 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 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 editor s, which will not be publis hed. 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Macrocytic anemia is associated with the severity of li ver impairment in patients with 
hepatitis B virus -related decompensated cirrhosis: a retrospective cross -sectional study  
 
Version: 0 Date: 08 Jul 2018  
 
Reviewer: Sei Kakinuma  
 
Reviewer's report:  
 
This is a manuscript describing that macrocytic anemia is associated with MELD score in HBV -
related decompensated LC. Authors showed several data that macrocytic anemia is associated 
with MELD score in HBV -related decompensated LC, ho wever, clinical significance of this 
study is unclear, because MELD score can already predict the prognosis of LC -patients. 
Moreover, the pathophysiology that macrocytic anemia is associated with MELD score, which 
was described in this study, was also uncl ear. There are several technical problems in this study.  
 
 
 
Specific points:  
 
#1. Clinical significance of this study is unclear, because MELD score can already predict the 
prognosis of LC -patients. Authors should show why the association between mean corpus cular 
volume (MCV) and MELD score is essential for the management of LC patients. Moreover, the 
most important factor associated with MELD score was cholesterol (OR -2.53, Table 2) in this 
study.  
 
 
#2. Why the authors analyzed the association between MCV a nd MELD score alone. How about 
the Child -Pugh score, or other scale? The pathophysiology that macrocytic anemia is associated 
with MELD score, which was described in this study, was also unclear.  
 
 
#3. In Table 1, MCV seems to be clearly correlated with age  of patients. Thus, it is possible that 
MCV is associated with MELD score (poor prognosis) via correlation with age. Authors should 
re-analyze the association of such factors using propensity score matching methods.  
 
 
#4. In Table 2, microscopic anemia was  not significant in univariate analysis. Why did the 
authors analyze "microscopic anemia" in multivariate analysis?  
 
 
 
 
 
Minor points  
 
There are several simple errors in this manuscript.  
 
#1. In Table 1, number or the % of drinking in normocytic group was wrong.  
 
#2. There are grammatical errors in this manuscript, and it should be edited by native speakers.  
 
 
 
Are the methods appropriate and well described?  
If not, please spe cify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
 
 
 
 
 
 
 
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 fro m 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 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 received reimbursements, fees, funding, or salary from an organization that 
holds or has appl ied 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 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 editor s, which will not be publis hed. 
 
I agree to the open peer review policy of the journal  
assistant