Reviewer's report
Title:Limitations of the MELD score in predicting mortality or need for removal
from waiting list in patients awaiting liver transplantation
Version: 2Date:3 August 2009
Reviewer: Michael A Fink
Reviewer's report:
The authors have addressed most of my concerns and those of the other
reviewers. I note, however, that a major error persists in the current version.
Table 4 identifies the sensitivity and specificity of CTP as 68.9% and 70.1%,
respectively and the sensitivity and specificity of MELD as 62.0% and 72.6%,
respectively. Derived from the table, the correct figures are: 69.0% and 70.5% for
CTP and 62.1% and 72.7% for MELD. In the abstract and the results section, the
sensitivity and specificity figures are reversed: "The sensitivity and specificity to
identify mortality or severe deterioration for CTP was 70.1% and 68.9%,
respectively; for MELD, it was 72.6% and 62.0%, respectively. "
In terms of determining the ideal cut-off for each of the measurements, this would
usually be derived from the ROC analysis. The authors report that the cut-offs
were "determined by minimizing the false positive and false negative results of
each score". It is not clear to me exactly how this was done and I think that the
appropriateness of this technique needs to be confirmed by a statistician.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Limitations of the MELD score in predicting mortality or need for removal
from waiting list in patients awaiting liver transplantation
Version: 2Date:3 August 2009
Reviewer: Michael A Fink
Reviewer's report:
The authors have addressed most of my concerns and those of the other
reviewers. I note, however, that a major error persists in the current version.
Table 4 identifies the sensitivity and specificity of CTP as 68.9% and 70.1%,
respectively and the sensitivity and specificity of MELD as 62.0% and 72.6%,
respectively. Derived from the table, the correct figures are: 69.0% and 70.5% for
CTP and 62.1% and 72.7% for MELD. In the abstract and the results section, the
sensitivity and specificity figures are reversed: "The sensitivity and specificity to
identify mortality or severe deterioration for CTP was 70.1% and 68.9%,
respectively; for MELD, it was 72.6% and 62.0%, respectively. "
In terms of determining the ideal cut-off for each of the measurements, this would
usually be derived from the ROC analysis. The authors report that the cut-offs
were "determined by minimizing the false positive and false negative results of
each score". It is not clear to me exactly how this was done and I think that the
appropriateness of this technique needs to be confirmed by a statistician.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Limitations of the MELD score in predicting mortality or need for removal
from waiting list in patients awaiting liver transplantation
Version: 2Date:3 August 2009
Reviewer: Michael A Fink
Reviewer's report:
The authors have addressed most of my concerns and those of the other
reviewers. I note, however, that a major error persists in the current version.
Table 4 identifies the sensitivity and specificity of CTP as 68.9% and 70.1%,
respectively and the sensitivity and specificity of MELD as 62.0% and 72.6%,
respectively. Derived from the table, the correct figures are: 69.0% and 70.5% for
CTP and 62.1% and 72.7% for MELD. In the abstract and the results section, the
sensitivity and specificity figures are reversed: "The sensitivity and specificity to
identify mortality or severe deterioration for CTP was 70.1% and 68.9%,
respectively; for MELD, it was 72.6% and 62.0%, respectively. "
In terms of determining the ideal cut-off for each of the measurements, this would
usually be derived from the ROC analysis. The authors report that the cut-offs
were "determined by minimizing the false positive and false negative results of
each score". It is not clear to me exactly how this was done and I think that the
appropriateness of this technique needs to be confirmed by a statistician.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
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