Reviewer's report
Title:Early liver biopsy, intraparenchymal cholestasis, and prognosis in patients
with alcoholic steatohepatitis
Version: 1Date:3 August 2011
Reviewer: Jerome Dumortier
Reviewer's report:
Alcoholic steatohepatitis (ASH) is a frequent acute liver disease associated with
a poor outcome. Therefore, prognostic factors and scores are needed to select
patients eligible for specific therapy. By now, patients with a severe form of ASH,
as defined by a Maddrey’s score >32 or a MELD score > 18, should be treated
with corticosteroids in order to decrease short-term mortality.
Spahr and coll. explored the prognostic value of several histological features
observed on initial liver biopsy in a large number of patients with documented
ASH, and no associated sepsis. The authors identified that marked
intraparenchymal cholestasis among the full spectrum of histological alterations
as an independent predictor of poor short term outcome together with age, INR
and serum creatinine. They proposed that this particular histological feature
could be combined with existing prognostic models.
I have some comments on the manuscript:
1. Methods
I believe that some biological tests are lacking. A specific focus is needed on the
diagnosis of current infection. The authors must clearly describe how current
infection was searched for (from ascitis, urine, lungs, …). In addition, pertinent
data such as WBC count, neutrophils count, C-reactive protein must be reported.
The authors included in analysis CP, Maddrey and MELD scores. Why did they
not include Lille-model or Glasgow score ?
2. Results
Again, my major comment is about infection. The authors described a cohort of
patients with ASH and no associated sepsis, but 11 patients died from … sepsis.
This must be discussed. Again WBC and neutrophils counts, CRP are lacking. I
do not understand why scores (CP, MELD, Maddrey, Lille, Glasgow) were not
included in univariate and multivariate analyses. I did not find the results of
univariate analysis (except on histological features).
Concerning the diagnosis of ASH, I am surprised by the high number of patients
without steatosis and/or neutrophils on liver biopsy. This must be discussed.
3. Discussion
The discussion must be modified according to my comments on Methods and
Results, especially the possible drawback concerning infection. In addition, a
discussion on all the other available prognostic scores is mandatory.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Early liver biopsy, intraparenchymal cholestasis, and prognosis in patients
with alcoholic steatohepatitis
Version: 1Date:3 August 2011
Reviewer: Jerome Dumortier
Reviewer's report:
Alcoholic steatohepatitis (ASH) is a frequent acute liver disease associated with
a poor outcome. Therefore, prognostic factors and scores are needed to select
patients eligible for specific therapy. By now, patients with a severe form of ASH,
as defined by a Maddrey’s score >32 or a MELD score > 18, should be treated
with corticosteroids in order to decrease short-term mortality.
Spahr and coll. explored the prognostic value of several histological features
observed on initial liver biopsy in a large number of patients with documented
ASH, and no associated sepsis. The authors identified that marked
intraparenchymal cholestasis among the full spectrum of histological alterations
as an independent predictor of poor short term outcome together with age, INR
and serum creatinine. They proposed that this particular histological feature
could be combined with existing prognostic models.
I have some comments on the manuscript:
1. Methods
I believe that some biological tests are lacking. A specific focus is needed on the
diagnosis of current infection. The authors must clearly describe how current
infection was searched for (from ascitis, urine, lungs, …). In addition, pertinent
data such as WBC count, neutrophils count, C-reactive protein must be reported.
The authors included in analysis CP, Maddrey and MELD scores. Why did they
not include Lille-model or Glasgow score ?
2. Results
Again, my major comment is about infection. The authors described a cohort of
patients with ASH and no associated sepsis, but 11 patients died from … sepsis.
This must be discussed. Again WBC and neutrophils counts, CRP are lacking. I
do not understand why scores (CP, MELD, Maddrey, Lille, Glasgow) were not
included in univariate and multivariate analyses. I did not find the results of
univariate analysis (except on histological features).
Concerning the diagnosis of ASH, I am surprised by the high number of patients
without steatosis and/or neutrophils on liver biopsy. This must be discussed.
3. Discussion
The discussion must be modified according to my comments on Methods and
Results, especially the possible drawback concerning infection. In addition, a
discussion on all the other available prognostic scores is mandatory.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Early liver biopsy, intraparenchymal cholestasis, and prognosis in patients
with alcoholic steatohepatitis
Version: 1Date:3 August 2011
Reviewer: Jerome Dumortier
Reviewer's report:
Alcoholic steatohepatitis (ASH) is a frequent acute liver disease associated with
a poor outcome. Therefore, prognostic factors and scores are needed to select
patients eligible for specific therapy. By now, patients with a severe form of ASH,
as defined by a Maddrey’s score >32 or a MELD score > 18, should be treated
with corticosteroids in order to decrease short-term mortality.
Spahr and coll. explored the prognostic value of several histological features
observed on initial liver biopsy in a large number of patients with documented
ASH, and no associated sepsis. The authors identified that marked
intraparenchymal cholestasis among the full spectrum of histological alterations
as an independent predictor of poor short term outcome together with age, INR
and serum creatinine. They proposed that this particular histological feature
could be combined with existing prognostic models.
I have some comments on the manuscript:
1. Methods
I believe that some biological tests are lacking. A specific focus is needed on the
diagnosis of current infection. The authors must clearly describe how current
infection was searched for (from ascitis, urine, lungs, …). In addition, pertinent
data such as WBC count, neutrophils count, C-reactive protein must be reported.
The authors included in analysis CP, Maddrey and MELD scores. Why did they
not include Lille-model or Glasgow score ?
2. Results
Again, my major comment is about infection. The authors described a cohort of
patients with ASH and no associated sepsis, but 11 patients died from … sepsis.
This must be discussed. Again WBC and neutrophils counts, CRP are lacking. I
do not understand why scores (CP, MELD, Maddrey, Lille, Glasgow) were not
included in univariate and multivariate analyses. I did not find the results of
univariate analysis (except on histological features).
Concerning the diagnosis of ASH, I am surprised by the high number of patients
without steatosis and/or neutrophils on liver biopsy. This must be discussed.
3. Discussion
The discussion must be modified according to my comments on Methods and
Results, especially the possible drawback concerning infection. In addition, a
discussion on all the other available prognostic scores is mandatory.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
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