Title: Characteristics of acute kidney injury and its impact on outcome in patients with acute-
on-chronic liver failure
Version: 0 Date: 13 Feb 2022
Reviewer's report:
This is an interesting study aimed at defining characteristics and outcomes of patients with
ACLF, defined by APAPL criteria. Authors describe characteristics of patients with AKI and
ACLF and developed a model to predict the probability to develop AKI in these patients. Authors
also found independent predictor factors for mortality in patients with ACLF.
MAIN COMMENTS
- The current study is similar with the study published by Zang et al. in 2016 that included mainly
the same targeted population, with the same aims and with a model for predicting AKI. The
main difference between current study and Zang’s study is that study from Zang et al. included
patients with ACLF diagnosed according to CMA criteria. Authors should further comment on
this point.
- Multivariate analysis. Authors nicely showed the significant differences between patients with
AKI and non-AKI. However, there is only one model for each multivariate analysis (also table
5), and authors did not report all the variables included in those models.
- Some of the variable included in the multivariate analysis seems not significant in the univariate
analysis (table 4).
- Mortality. How many patients received liver transplantation? How was it analyzed? This needs
to be addressed.
MINOR COMMENTS.
- Despite other authors reported similar results of the current study, other studies that compared
C-AKI and H-AKI are somehow different. Authors should comment that.
- Fluctuated-in situ. Authors might rename his type of AKI, as for instance “persistent”.
- Authors should report how many patients used admission creatinine as baseline creatinine?
- Methods. Authors should describe in methods section the characteristics of validation cohort.
- Methods. Authors should explain the definitions used to define the different types of AKI.
- This study included patients with ACLF according to ASPLP definitions. How many patients
had liver cirrhosis?
- Figure 3C. How was selected the cut-off of srCr of 133mmol/L?
- There are some spelling mistakes (for example: “livre” disease, page 15 line 299.).
- Authors should specify the overall mortality and explain if 90-day mortality model includes
all the cohort or only patients with AKI.
- Discussion. Authors might summarize the discussion. In addition, from “circulatory
dysfunction…. To causing kidney dysfunction.” is a description of the pathophysiology of
cirrhosis, however it is not linked with the results of the study.
- Discussion. Authors should mention and explain the limitations of the study. Such as: it is a
retrospective study, and so on.
- Conclusions/Discussion. Authors should add that the message: “It will be interesting to study
or test PK-AKI model in patients with cirrhosis but without ACLF”.
- Legend at page 13 should be Zang not Xin.
Title: Characteristics of acute kidney injury and its impact on outcome in patients with acute-
on-chronic liver failure
Version: 0 Date: 13 Feb 2022
Reviewer's report:
This is an interesting study aimed at defining characteristics and outcomes of patients with
ACLF, defined by APAPL criteria. Authors describe characteristics of patients with AKI and
ACLF and developed a model to predict the probability to develop AKI in these patients. Authors
also found independent predictor factors for mortality in patients with ACLF.
MAIN COMMENTS
- The current study is similar with the study published by Zang et al. in 2016 that included mainly
the same targeted population, with the same aims and with a model for predicting AKI. The
main difference between current study and Zang’s study is that study from Zang et al. included
patients with ACLF diagnosed according to CMA criteria. Authors should further comment on
this point.
- Multivariate analysis. Authors nicely showed the significant differences between patients with
AKI and non-AKI. However, there is only one model for each multivariate analysis (also table
5), and authors did not report all the variables included in those models.
- Some of the variable included in the multivariate analysis seems not significant in the univariate
analysis (table 4).
- Mortality. How many patients received liver transplantation? How was it analyzed? This needs
to be addressed.
MINOR COMMENTS.
- Despite other authors reported similar results of the current study, other studies that compared
C-AKI and H-AKI are somehow different. Authors should comment that.
- Fluctuated-in situ. Authors might rename his type of AKI, as for instance “persistent”.
- Authors should report how many patients used admission creatinine as baseline creatinine?
- Methods. Authors should describe in methods section the characteristics of validation cohort.
- Methods. Authors should explain the definitions used to define the different types of AKI.
- This study included patients with ACLF according to ASPLP definitions. How many patients
had liver cirrhosis?
- Figure 3C. How was selected the cut-off of srCr of 133mmol/L?
- There are some spelling mistakes (for example: “livre” disease, page 15 line 299.).
- Authors should specify the overall mortality and explain if 90-day mortality model includes
all the cohort or only patients with AKI.
- Discussion. Authors might summarize the discussion. In addition, from “circulatory
dysfunction…. To causing kidney dysfunction.” is a description of the pathophysiology of
cirrhosis, however it is not linked with the results of the study.
- Discussion. Authors should mention and explain the limitations of the study. Such as: it is a
retrospective study, and so on.
- Conclusions/Discussion. Authors should add that the message: “It will be interesting to study
or test PK-AKI model in patients with cirrhosis but without ACLF”.
- Legend at page 13 should be Zang not Xin.
Please review this paper.
user
Title: Characteristics of acute kidney injury and its impact on outcome in patients with acute-
on-chronic liver failure
Version: 0 Date: 13 Feb 2022
Reviewer's report:
This is an interesting study aimed at defining characteristics and outcomes of patients with
ACLF, defined by APAPL criteria. Authors describe characteristics of patients with AKI and
ACLF and developed a model to predict the probability to develop AKI in these patients. Authors
also found independent predictor factors for mortality in patients with ACLF.
MAIN COMMENTS
- The current study is similar with the study published by Zang et al. in 2016 that included mainly
the same targeted population, with the same aims and with a model for predicting AKI. The
main difference between current study and Zang’s study is that study from Zang et al. included
patients with ACLF diagnosed according to CMA criteria. Authors should further comment on
this point.
- Multivariate analysis. Authors nicely showed the significant differences between patients with
AKI and non-AKI. However, there is only one model for each multivariate analysis (also table
5), and authors did not report all the variables included in those models.
- Some of the variable included in the multivariate analysis seems not significant in the univariate
analysis (table 4).
- Mortality. How many patients received liver transplantation? How was it analyzed? This needs
to be addressed.
MINOR COMMENTS.
- Despite other authors reported similar results of the current study, other studies that compared
C-AKI and H-AKI are somehow different. Authors should comment that.
- Fluctuated-in situ. Authors might rename his type of AKI, as for instance “persistent”.
- Authors should report how many patients used admission creatinine as baseline creatinine?
- Methods. Authors should describe in methods section the characteristics of validation cohort.
- Methods. Authors should explain the definitions used to define the different types of AKI.
- This study included patients with ACLF according to ASPLP definitions. How many patients
had liver cirrhosis?
- Figure 3C. How was selected the cut-off of srCr of 133mmol/L?
- There are some spelling mistakes (for example: “livre” disease, page 15 line 299.).
- Authors should specify the overall mortality and explain if 90-day mortality model includes
all the cohort or only patients with AKI.
- Discussion. Authors might summarize the discussion. In addition, from “circulatory
dysfunction…. To causing kidney dysfunction.” is a description of the pathophysiology of
cirrhosis, however it is not linked with the results of the study.
- Discussion. Authors should mention and explain the limitations of the study. Such as: it is a
retrospective study, and so on.
- Conclusions/Discussion. Authors should add that the message: “It will be interesting to study
or test PK-AKI model in patients with cirrhosis but without ACLF”.
- Legend at page 13 should be Zang not Xin.
assistant