Title: Association and Temporal Sequence of Pneumonia and Gastrointestinal Bleeding after
Acute Ischemic Stroke
Version: 1 Date: 24 Mar 2024
Reviewer:  Zhu Shi
Reviewer's report:
This study used a prospective, large-size AIS cohort to compare two common complications on
the occurrence time, and the results were interesting. However, I have a few concerns about it.
1. It may be inaccurate to define the timing of SAP and GIB only in terms of diagnosis
establishment. This is due to the fact that the clinical symptoms of GIB may be more insidious
than ARP.
2. The occurrence of GIB is not only directly related to the use of antithrombotic and
anticoagulant drugs, but also closely related to risk factros including age, female gender,
previous history of gastric ulcer, and positivity of H. pylori. In the present study yet there was
no difference between GIB and non-GIB patients, which was different from previous studies
and the reasons need to be analysed in discussion.
3. In fact, both SRP and GIB often occur in patients with posterior circulation infarcts and those
with more severe stroke (higher NIHSS score). The relationship is most likely to be correlative
rather than causal-effect. A stratified analysis of the distribution and extent of infarction would
be more convincing.
Title: Association and Temporal Sequence of Pneumonia and Gastrointestinal Bleeding after
Acute Ischemic Stroke
Version: 1 Date: 24 Mar 2024
Reviewer:  Zhu Shi
Reviewer's report:
This study used a prospective, large-size AIS cohort to compare two common complications on
the occurrence time, and the results were interesting. However, I have a few concerns about it.
1. It may be inaccurate to define the timing of SAP and GIB only in terms of diagnosis
establishment. This is due to the fact that the clinical symptoms of GIB may be more insidious
than ARP.
2. The occurrence of GIB is not only directly related to the use of antithrombotic and
anticoagulant drugs, but also closely related to risk factros including age, female gender,
previous history of gastric ulcer, and positivity of H. pylori. In the present study yet there was
no difference between GIB and non-GIB patients, which was different from previous studies
and the reasons need to be analysed in discussion.
3. In fact, both SRP and GIB often occur in patients with posterior circulation infarcts and those
with more severe stroke (higher NIHSS score). The relationship is most likely to be correlative
rather than causal-effect. A stratified analysis of the distribution and extent of infarction would
be more convincing.
Please review this paper.
user
Title: Association and Temporal Sequence of Pneumonia and Gastrointestinal Bleeding after
Acute Ischemic Stroke
Version: 1 Date: 24 Mar 2024
Reviewer:  Zhu Shi
Reviewer's report:
This study used a prospective, large-size AIS cohort to compare two common complications on
the occurrence time, and the results were interesting. However, I have a few concerns about it.
1. It may be inaccurate to define the timing of SAP and GIB only in terms of diagnosis
establishment. This is due to the fact that the clinical symptoms of GIB may be more insidious
than ARP.
2. The occurrence of GIB is not only directly related to the use of antithrombotic and
anticoagulant drugs, but also closely related to risk factros including age, female gender,
previous history of gastric ulcer, and positivity of H. pylori. In the present study yet there was
no difference between GIB and non-GIB patients, which was different from previous studies
and the reasons need to be analysed in discussion.
3. In fact, both SRP and GIB often occur in patients with posterior circulation infarcts and those
with more severe stroke (higher NIHSS score). The relationship is most likely to be correlative
rather than causal-effect. A stratified analysis of the distribution and extent of infarction would
be more convincing.
assistant