Reviewer ’s report  
 
Title: Macrocytic anemia is associated with the severity of li ver impairment in patients with 
hepatitis B virus -related decompensated cirrhosis: a retrospective cross -sectional study  
 
Version: 1 Date: 17 Sep 2018  
 
Reviewer: Sei Kakinuma  
 
Reviewer's report:  
 
This is the revised manuscript describing that macrocytic anemia is associated with MELD score 
of HBV -related decompensated liver cirrhosis (LC). Authors revised several points and errors 
suggested by the reviewers. However, se veral problems are still unsolved in this manuscript.  
 
 
The clinical significance remains unclear. Which of MELD score and MCV is better predictor of 
patients' prognosis? Moreover, the relationship between MCV and other factors related to liver 
function, in cluding Child -Pugh score, remains unclear.  
 
 
 
Major points.  
 
#1. The clinical significance of this study still remains unclear. Which of MELD score and MCV 
is better predictor of patients' prognosis? Authors should show the comparison MELD score with 
MCV as a predictor of patients' prognosis. Why did the authors analyze HBV -related LC alone? 
How about HCV -related LC or NASH -related LC? Authors should discuss whether difference of 
etiology influences the association of MCV with MELD score.  
 
 
#2. The relationshi p between MCV and other factors related to liver function, including Child -
Pugh score, remains unclear. Authors should show the most significant factor associated with 
MCV in patients with LC. Is the most significant factor associated with MCV MELD score?  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclu sions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, f ees, funding, or salary from an 
organisation t hat may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, e ither 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 rel ating 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 compet ing interests' 
below . If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, i f the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer  review policy of the journal  
Reviewer ’s report  
 
Title: Macrocytic anemia is associated with the severity of li ver impairment in patients with 
hepatitis B virus -related decompensated cirrhosis: a retrospective cross -sectional study  
 
Version: 1 Date: 17 Sep 2018  
 
Reviewer: Sei Kakinuma  
 
Reviewer's report:  
 
This is the revised manuscript describing that macrocytic anemia is associated with MELD score 
of HBV -related decompensated liver cirrhosis (LC). Authors revised several points and errors 
suggested by the reviewers. However, se veral problems are still unsolved in this manuscript.  
 
 
The clinical significance remains unclear. Which of MELD score and MCV is better predictor of 
patients' prognosis? Moreover, the relationship between MCV and other factors related to liver 
function, in cluding Child -Pugh score, remains unclear.  
 
 
 
Major points.  
 
#1. The clinical significance of this study still remains unclear. Which of MELD score and MCV 
is better predictor of patients' prognosis? Authors should show the comparison MELD score with 
MCV as a predictor of patients' prognosis. Why did the authors analyze HBV -related LC alone? 
How about HCV -related LC or NASH -related LC? Authors should discuss whether difference of 
etiology influences the association of MCV with MELD score.  
 
 
#2. The relationshi p between MCV and other factors related to liver function, including Child -
Pugh score, remains unclear. Authors should show the most significant factor associated with 
MCV in patients with LC. Is the most significant factor associated with MCV MELD score?  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclu sions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, f ees, funding, or salary from an 
organisation t hat may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, e ither 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 rel ating 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 compet ing interests' 
below . If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, i f the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer  review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Macrocytic anemia is associated with the severity of li ver impairment in patients with 
hepatitis B virus -related decompensated cirrhosis: a retrospective cross -sectional study  
 
Version: 1 Date: 17 Sep 2018  
 
Reviewer: Sei Kakinuma  
 
Reviewer's report:  
 
This is the revised manuscript describing that macrocytic anemia is associated with MELD score 
of HBV -related decompensated liver cirrhosis (LC). Authors revised several points and errors 
suggested by the reviewers. However, se veral problems are still unsolved in this manuscript.  
 
 
The clinical significance remains unclear. Which of MELD score and MCV is better predictor of 
patients' prognosis? Moreover, the relationship between MCV and other factors related to liver 
function, in cluding Child -Pugh score, remains unclear.  
 
 
 
Major points.  
 
#1. The clinical significance of this study still remains unclear. Which of MELD score and MCV 
is better predictor of patients' prognosis? Authors should show the comparison MELD score with 
MCV as a predictor of patients' prognosis. Why did the authors analyze HBV -related LC alone? 
How about HCV -related LC or NASH -related LC? Authors should discuss whether difference of 
etiology influences the association of MCV with MELD score.  
 
 
#2. The relationshi p between MCV and other factors related to liver function, including Child -
Pugh score, remains unclear. Authors should show the most significant factor associated with 
MCV in patients with LC. Is the most significant factor associated with MCV MELD score?  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclu sions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, f ees, funding, or salary from an 
organisation t hat may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, e ither 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 rel ating 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 compet ing interests' 
below . If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, i f the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer  review policy of the journal  
assistant