Reviewer’s report
Title: 
Establishment and Evaluation of an Early Prediction Model of
Hepatorenal Syndrome in Patients with Decompensated Hepatitis B Cirrhosis
Version: 
0 
Date: 
05 Jun 2022
Reviewer: 
Khaled Farid
Reviewer's report:
In this work the authors constructed a model for prediction of HRS in patients
with decompensated HBV-cirrhosis.
The idea is good and innovative but the manuscript needs major revision before
acceptance for publication.
Generally, the introduction is weak needs potentiation by more knowledge about
hepatorenal syndrome (HRS) regarding prevalence, pathophysiology and
diagnostic criteria in addition to the role of the treating physician in prevention
of HRS. Discussion needs reconstruction and better explanation of the results
and comparison to works by others. Many abbreviations need to be spilled of
when first written. The language should be revised by an English native
specialist.
Some important comments for the authors to improve the manuscript
Abstract:
Page 3; line 25: "diagnosis of hepatprenal syndrome" not "diagnosis of liver
fibrosis"
Introduction:
Page 3; line 54: What do you mean by "decompensated HRS"?
Page 3; line 58: The paragraph " In this study……in the clinic" should not be
here in the introduction.
Materials and methods:
Page 4; line 12: Inclusion criteria should be revised; patients with
Decompensated cirrhosis with or without HRS according to the diagnostic
criteria, proof of HBV etiology, excluding other viral and non-viral etiology,
cirrhosis diagnosed clinically and by imaging with no need to biopsy.
Being a retrospective study, how do you reach the patients to obtain an informed
consent?
Page 4; line 40: the diagnostic criteria of HRS should be revised according to
your reference Angeli et al 2019.
Page 4; line 58: "The P value of the regression model was 0.05, and the
exclusion P value was 0.05." How? 
Results:
Page 5; line 11: you should differentiate the training set from the validation set
as in Fig 1 and define the number of patients with HRS in each group.
Did you start with data of patents with decompensated HBV-cirrhosis and
followed till part of them developed HRS? or compare patients with and without
HRS?
There should be a table of comparison between Patients with and those without
HRS to show variables of significance before the logistic regression analysis.
You should define if the logistic regression analysis was done for the training set
only or for all the 255 patients.
In tables 2 and 3 did you mean all the 255 patients or only the training set?
Page 5; line 34-37: What "z" and "t" refers to?
Page 5; line 48-51: the cutoff value here (>0.146) differs than that in Fig 4
(0.901)??
Page 5; line 54-55: Table 4 instead of table3. 22 patients and 13 patients of all
the series or of the training set? What do you mean by treated and followed up?
Page 5; line 59: "Among 46 patients…." 46 or (22+13) what is the difference???
Discussion:
Page 6; line 29-33: each biomarker should have its reference.
Page 6; line 37-40: This means that you collect the data of patients with
decompensated HBV-cirrhosis before developing HRS and followed them till
some of them develop HRS and then compared the variables of those with and
those without HRS???
Page 6; line 46-47: Here you start to differentiate the training set from the
validation one by third different number (22+5) or 46 or (22+13). What is the
difference????
Page 7; line 29-37: Comparing your model with Child score appears illogic as
none uses the Child score for prediction of HRS. If you want, it is more logic to
compare it with MELD though it has not been used also to predict HRS.
Publons Reviewer Recognition
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find the details of processing in Publons’ privacy policy
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Yes
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 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 manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. 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.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Establishment and Evaluation of an Early Prediction Model of
Hepatorenal Syndrome in Patients with Decompensated Hepatitis B Cirrhosis
Version: 
0 
Date: 
05 Jun 2022
Reviewer: 
Khaled Farid
Reviewer's report:
In this work the authors constructed a model for prediction of HRS in patients
with decompensated HBV-cirrhosis.
The idea is good and innovative but the manuscript needs major revision before
acceptance for publication.
Generally, the introduction is weak needs potentiation by more knowledge about
hepatorenal syndrome (HRS) regarding prevalence, pathophysiology and
diagnostic criteria in addition to the role of the treating physician in prevention
of HRS. Discussion needs reconstruction and better explanation of the results
and comparison to works by others. Many abbreviations need to be spilled of
when first written. The language should be revised by an English native
specialist.
Some important comments for the authors to improve the manuscript
Abstract:
Page 3; line 25: "diagnosis of hepatprenal syndrome" not "diagnosis of liver
fibrosis"
Introduction:
Page 3; line 54: What do you mean by "decompensated HRS"?
Page 3; line 58: The paragraph " In this study……in the clinic" should not be
here in the introduction.
Materials and methods:
Page 4; line 12: Inclusion criteria should be revised; patients with
Decompensated cirrhosis with or without HRS according to the diagnostic
criteria, proof of HBV etiology, excluding other viral and non-viral etiology,
cirrhosis diagnosed clinically and by imaging with no need to biopsy.
Being a retrospective study, how do you reach the patients to obtain an informed
consent?
Page 4; line 40: the diagnostic criteria of HRS should be revised according to
your reference Angeli et al 2019.
Page 4; line 58: "The P value of the regression model was 0.05, and the
exclusion P value was 0.05." How? 
Results:
Page 5; line 11: you should differentiate the training set from the validation set
as in Fig 1 and define the number of patients with HRS in each group.
Did you start with data of patents with decompensated HBV-cirrhosis and
followed till part of them developed HRS? or compare patients with and without
HRS?
There should be a table of comparison between Patients with and those without
HRS to show variables of significance before the logistic regression analysis.
You should define if the logistic regression analysis was done for the training set
only or for all the 255 patients.
In tables 2 and 3 did you mean all the 255 patients or only the training set?
Page 5; line 34-37: What "z" and "t" refers to?
Page 5; line 48-51: the cutoff value here (>0.146) differs than that in Fig 4
(0.901)??
Page 5; line 54-55: Table 4 instead of table3. 22 patients and 13 patients of all
the series or of the training set? What do you mean by treated and followed up?
Page 5; line 59: "Among 46 patients…." 46 or (22+13) what is the difference???
Discussion:
Page 6; line 29-33: each biomarker should have its reference.
Page 6; line 37-40: This means that you collect the data of patients with
decompensated HBV-cirrhosis before developing HRS and followed them till
some of them develop HRS and then compared the variables of those with and
those without HRS???
Page 6; line 46-47: Here you start to differentiate the training set from the
validation one by third different number (22+5) or 46 or (22+13). What is the
difference????
Page 7; line 29-37: Comparing your model with Child score appears illogic as
none uses the Child score for prediction of HRS. If you want, it is more logic to
compare it with MELD though it has not been used also to predict HRS.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 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 manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. 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.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Establishment and Evaluation of an Early Prediction Model of
Hepatorenal Syndrome in Patients with Decompensated Hepatitis B Cirrhosis
Version: 
0 
Date: 
05 Jun 2022
Reviewer: 
Khaled Farid
Reviewer's report:
In this work the authors constructed a model for prediction of HRS in patients
with decompensated HBV-cirrhosis.
The idea is good and innovative but the manuscript needs major revision before
acceptance for publication.
Generally, the introduction is weak needs potentiation by more knowledge about
hepatorenal syndrome (HRS) regarding prevalence, pathophysiology and
diagnostic criteria in addition to the role of the treating physician in prevention
of HRS. Discussion needs reconstruction and better explanation of the results
and comparison to works by others. Many abbreviations need to be spilled of
when first written. The language should be revised by an English native
specialist.
Some important comments for the authors to improve the manuscript
Abstract:
Page 3; line 25: "diagnosis of hepatprenal syndrome" not "diagnosis of liver
fibrosis"
Introduction:
Page 3; line 54: What do you mean by "decompensated HRS"?
Page 3; line 58: The paragraph " In this study……in the clinic" should not be
here in the introduction.
Materials and methods:
Page 4; line 12: Inclusion criteria should be revised; patients with
Decompensated cirrhosis with or without HRS according to the diagnostic
criteria, proof of HBV etiology, excluding other viral and non-viral etiology,
cirrhosis diagnosed clinically and by imaging with no need to biopsy.
Being a retrospective study, how do you reach the patients to obtain an informed
consent?
Page 4; line 40: the diagnostic criteria of HRS should be revised according to
your reference Angeli et al 2019.
Page 4; line 58: "The P value of the regression model was 0.05, and the
exclusion P value was 0.05." How? 
Results:
Page 5; line 11: you should differentiate the training set from the validation set
as in Fig 1 and define the number of patients with HRS in each group.
Did you start with data of patents with decompensated HBV-cirrhosis and
followed till part of them developed HRS? or compare patients with and without
HRS?
There should be a table of comparison between Patients with and those without
HRS to show variables of significance before the logistic regression analysis.
You should define if the logistic regression analysis was done for the training set
only or for all the 255 patients.
In tables 2 and 3 did you mean all the 255 patients or only the training set?
Page 5; line 34-37: What "z" and "t" refers to?
Page 5; line 48-51: the cutoff value here (>0.146) differs than that in Fig 4
(0.901)??
Page 5; line 54-55: Table 4 instead of table3. 22 patients and 13 patients of all
the series or of the training set? What do you mean by treated and followed up?
Page 5; line 59: "Among 46 patients…." 46 or (22+13) what is the difference???
Discussion:
Page 6; line 29-33: each biomarker should have its reference.
Page 6; line 37-40: This means that you collect the data of patients with
decompensated HBV-cirrhosis before developing HRS and followed them till
some of them develop HRS and then compared the variables of those with and
those without HRS???
Page 6; line 46-47: Here you start to differentiate the training set from the
validation one by third different number (22+5) or 46 or (22+13). What is the
difference????
Page 7; line 29-37: Comparing your model with Child score appears illogic as
none uses the Child score for prediction of HRS. If you want, it is more logic to
compare it with MELD though it has not been used also to predict HRS.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 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 manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. 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.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant