Reviewer’s report
Title: Prognostic factors of acute mesenteric ischemia in ICU patients
Version: 0 Date: 31 Jul 2018
Reviewer: Stefan Acosta
Reviewer's report:
Overall evaluation: 
Retrospective long series of AMI patients at the ICU. Patients with mesenteric venous thrombosis is a  
very  different  patient  population  than  arterial  AMI  -  younger,  less  comorbidities  and  responds  
favourable to anticoagulation. The 14 patients with MVT should be excluded from these series - and  
clearly declared in the method section. The favourable prognostic factor anticoagulation is linked to  
mesenteric venous thrombosis, active treatment and integrated in surviving. This confounding factors  
can not be controlled for in the analysis - and "anticoagulation" as a prognostic factor should be  
omitted.   The  two  independent  prognostic  findings,  vasopressor  therapy  intensity  and  increasing  
lactate, are expected. Lactate is a marker of death whatever the cause, and this should be discussed with  
insertion  of  new  references.  Limitation  of  the  study section:  The  material  does  not  allow  clear  
distinction between acute occlusive and non-occlusive arterial mesenteric disease. The CTs in the  
remote time period would have great difficulties in this distinction. The result section should be better  
structured with subheadings. There is very little exchange in new references in the discussion. Some of  
the  tables  has  to  be  revised  (omit  venous  thrombosis  patients).  The  AUC  graphs  are  scientific  
unnecessary and do not add information - as it is right now more misinformation (incorporating  
anticoagulation as a parameter is not appropiate). Please omit those graphs.
Specific comment:
Results: "Furthermore, for the latter, primary diagnosis was typically not AMI", First "Furthermore"  
should be omitted since Results should stand alone without interpretation. Secondly, what was the  
primary diagnosis in those that survived or died? In the Table there is some estimation, but this  
statement requires more data or the sentence should be omitted.
Results:  Why  is  arterial  hypertension  favourable  for  prognosis  in  the  uni-variable  analysis?  
Confounding as it was not a significant factor in the multi-variable analysis (last Table)? This fact was  
not elaborated on. Perhaps add some explanation(s) in the discussion.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
I am able to assess the statistics
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, 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
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for 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 included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title: Prognostic factors of acute mesenteric ischemia in ICU patients
Version: 0 Date: 31 Jul 2018
Reviewer: Stefan Acosta
Reviewer's report:
Overall evaluation: 
Retrospective long series of AMI patients at the ICU. Patients with mesenteric venous thrombosis is a  
very  different  patient  population  than  arterial  AMI  -  younger,  less  comorbidities  and  responds  
favourable to anticoagulation. The 14 patients with MVT should be excluded from these series - and  
clearly declared in the method section. The favourable prognostic factor anticoagulation is linked to  
mesenteric venous thrombosis, active treatment and integrated in surviving. This confounding factors  
can not be controlled for in the analysis - and "anticoagulation" as a prognostic factor should be  
omitted.   The  two  independent  prognostic  findings,  vasopressor  therapy  intensity  and  increasing  
lactate, are expected. Lactate is a marker of death whatever the cause, and this should be discussed with  
insertion  of  new  references.  Limitation  of  the  study section:  The  material  does  not  allow  clear  
distinction between acute occlusive and non-occlusive arterial mesenteric disease. The CTs in the  
remote time period would have great difficulties in this distinction. The result section should be better  
structured with subheadings. There is very little exchange in new references in the discussion. Some of  
the  tables  has  to  be  revised  (omit  venous  thrombosis  patients).  The  AUC  graphs  are  scientific  
unnecessary and do not add information - as it is right now more misinformation (incorporating  
anticoagulation as a parameter is not appropiate). Please omit those graphs.
Specific comment:
Results: "Furthermore, for the latter, primary diagnosis was typically not AMI", First "Furthermore"  
should be omitted since Results should stand alone without interpretation. Secondly, what was the  
primary diagnosis in those that survived or died? In the Table there is some estimation, but this  
statement requires more data or the sentence should be omitted.
Results:  Why  is  arterial  hypertension  favourable  for  prognosis  in  the  uni-variable  analysis?  
Confounding as it was not a significant factor in the multi-variable analysis (last Table)? This fact was  
not elaborated on. Perhaps add some explanation(s) in the discussion.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
I am able to assess the statistics
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, 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
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for 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 included as confidential comments to the editors, 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: Prognostic factors of acute mesenteric ischemia in ICU patients
Version: 0 Date: 31 Jul 2018
Reviewer: Stefan Acosta
Reviewer's report:
Overall evaluation: 
Retrospective long series of AMI patients at the ICU. Patients with mesenteric venous thrombosis is a  
very  different  patient  population  than  arterial  AMI  -  younger,  less  comorbidities  and  responds  
favourable to anticoagulation. The 14 patients with MVT should be excluded from these series - and  
clearly declared in the method section. The favourable prognostic factor anticoagulation is linked to  
mesenteric venous thrombosis, active treatment and integrated in surviving. This confounding factors  
can not be controlled for in the analysis - and "anticoagulation" as a prognostic factor should be  
omitted.   The  two  independent  prognostic  findings,  vasopressor  therapy  intensity  and  increasing  
lactate, are expected. Lactate is a marker of death whatever the cause, and this should be discussed with  
insertion  of  new  references.  Limitation  of  the  study section:  The  material  does  not  allow  clear  
distinction between acute occlusive and non-occlusive arterial mesenteric disease. The CTs in the  
remote time period would have great difficulties in this distinction. The result section should be better  
structured with subheadings. There is very little exchange in new references in the discussion. Some of  
the  tables  has  to  be  revised  (omit  venous  thrombosis  patients).  The  AUC  graphs  are  scientific  
unnecessary and do not add information - as it is right now more misinformation (incorporating  
anticoagulation as a parameter is not appropiate). Please omit those graphs.
Specific comment:
Results: "Furthermore, for the latter, primary diagnosis was typically not AMI", First "Furthermore"  
should be omitted since Results should stand alone without interpretation. Secondly, what was the  
primary diagnosis in those that survived or died? In the Table there is some estimation, but this  
statement requires more data or the sentence should be omitted.
Results:  Why  is  arterial  hypertension  favourable  for  prognosis  in  the  uni-variable  analysis?  
Confounding as it was not a significant factor in the multi-variable analysis (last Table)? This fact was  
not elaborated on. Perhaps add some explanation(s) in the discussion.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
I am able to assess the statistics
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, 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
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for 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 included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
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