Reviewer's report 
 Serum hyaluronate as a non invasive marker of hepatic fibrosis and inflammation in chronic Title: 
HBV infection 
 1  12 May 2005 Version: Date: 
 Thierry Poynard Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
1. The most interesting group of patients are patients with HBV infection but without decompensated 
cirrhosis as in this group there is no need of fibrosis biomarkers. Therefore the primary endpoint 
should be the diagnosis of advanced fibrosis (including or not decompensated cirrhosis). The 
respective AUROCs should be performed excluding the control group without HBV infection. It is not 
clear from the AUROC data if he controls were excluded. 
2. Table 4. Details of the number of subjects should be given, not only the percentages. 
3. Quality of biopsies sample should be detailed: length, fragments, number of portal tracts. 
4. Discordant cases between hyaluronate and biopsy should be discussed both from the risk of 
failure from hyaluronate and from biopsy sampling error. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
Abstract : 
5. Delete reference to inflammation which not the primary endpoint for the diagnostic value of 
hyaluronate. 
6. Modify the sentence giving an AUROC for a cut-off, as by definition the AUROC is calculated for all the values of a quantitative test. 
7. References concerning Fibrotest-ActiTest-Fibrosure which is the most studied biomarkers are 
lacking particularly reference in HBV (Myers et al J Hepatol) 8. The definition of upper limit of normal should be defined due to the inter laboratory variability 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I have a conflict of interest as I am the inventor of FibroTest and I have a capital interest in the 
startup company from Paris University marketing FibroTest. 
Reviewer's report 
 Serum hyaluronate as a non invasive marker of hepatic fibrosis and inflammation in chronic Title: 
HBV infection 
 1  12 May 2005 Version: Date: 
 Thierry Poynard Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
1. The most interesting group of patients are patients with HBV infection but without decompensated 
cirrhosis as in this group there is no need of fibrosis biomarkers. Therefore the primary endpoint 
should be the diagnosis of advanced fibrosis (including or not decompensated cirrhosis). The 
respective AUROCs should be performed excluding the control group without HBV infection. It is not 
clear from the AUROC data if he controls were excluded. 
2. Table 4. Details of the number of subjects should be given, not only the percentages. 
3. Quality of biopsies sample should be detailed: length, fragments, number of portal tracts. 
4. Discordant cases between hyaluronate and biopsy should be discussed both from the risk of 
failure from hyaluronate and from biopsy sampling error. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
Abstract : 
5. Delete reference to inflammation which not the primary endpoint for the diagnostic value of 
hyaluronate. 
6. Modify the sentence giving an AUROC for a cut-off, as by definition the AUROC is calculated for all the values of a quantitative test. 
7. References concerning Fibrotest-ActiTest-Fibrosure which is the most studied biomarkers are 
lacking particularly reference in HBV (Myers et al J Hepatol) 8. The definition of upper limit of normal should be defined due to the inter laboratory variability 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I have a conflict of interest as I am the inventor of FibroTest and I have a capital interest in the 
startup company from Paris University marketing FibroTest. 
Please review this paper.
user
Reviewer's report 
 Serum hyaluronate as a non invasive marker of hepatic fibrosis and inflammation in chronic Title: 
HBV infection 
 1  12 May 2005 Version: Date: 
 Thierry Poynard Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
1. The most interesting group of patients are patients with HBV infection but without decompensated 
cirrhosis as in this group there is no need of fibrosis biomarkers. Therefore the primary endpoint 
should be the diagnosis of advanced fibrosis (including or not decompensated cirrhosis). The 
respective AUROCs should be performed excluding the control group without HBV infection. It is not 
clear from the AUROC data if he controls were excluded. 
2. Table 4. Details of the number of subjects should be given, not only the percentages. 
3. Quality of biopsies sample should be detailed: length, fragments, number of portal tracts. 
4. Discordant cases between hyaluronate and biopsy should be discussed both from the risk of 
failure from hyaluronate and from biopsy sampling error. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
Abstract : 
5. Delete reference to inflammation which not the primary endpoint for the diagnostic value of 
hyaluronate. 
6. Modify the sentence giving an AUROC for a cut-off, as by definition the AUROC is calculated for all the values of a quantitative test. 
7. References concerning Fibrotest-ActiTest-Fibrosure which is the most studied biomarkers are 
lacking particularly reference in HBV (Myers et al J Hepatol) 8. The definition of upper limit of normal should be defined due to the inter laboratory variability 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I have a conflict of interest as I am the inventor of FibroTest and I have a capital interest in the 
startup company from Paris University marketing FibroTest. 
assistant