Title: Prognostic clinical indexes for prediction of acute gangrenous cholecystitis and acute
purulent cholecystitis
Version: 4 Date: 16 Jul 2022
Reviewer's report:
Chen et al. performed retrospective study to identify preoperatively predictive factors for
severe cholecystitis, such as gangrenous cholecystitis, acute gangrenous cholecystitis, and acute
purulent cholecystitis. This is interesting subject, however, the description of manuscript is
immature. I have the following comments and questions.
1) This study has limitations as it is a retrospective study with a small number of included
patients. A description of these limitations is required in discussion.
2) The baseline characteristics of the study population were not described in this study. The
patients’ characteristics can also influence their surgical outcomes. Please add the patients’
baseline characteristics (ex, Age, ASA, BMI, previous abdominal surgery history, etc)
3) Authors described “Preoperative prediction of severe cholecystitis (SC) is of great
significance, as the mortality and complication rate of SC is much higher that of chronic
cholecystitis. However, your study does not show surgical outcomes such as operation time,
intraoperative and postoperative complication, and mortality for each diagnosis. Please add the
surgical outcomes.
4) Recently, even in patients with severe cholecystitis, most cholecystectomy is performed
laparoscopically. However, in your study, most patients underwent open cholecystectomy. This
needs further explanation.
5) Authors showed that the GBWT, the percentage of neutrophils and WBC could be used to
differentiate APC, AGC, GC and CC, using ROC curve analysis. However, in order to confirm
the accuracy of this analyses, it is considered that multivariate analysis including other co-
variants that may have an effect is required.
Title: Prognostic clinical indexes for prediction of acute gangrenous cholecystitis and acute
purulent cholecystitis
Version: 4 Date: 16 Jul 2022
Reviewer's report:
Chen et al. performed retrospective study to identify preoperatively predictive factors for
severe cholecystitis, such as gangrenous cholecystitis, acute gangrenous cholecystitis, and acute
purulent cholecystitis. This is interesting subject, however, the description of manuscript is
immature. I have the following comments and questions.
1) This study has limitations as it is a retrospective study with a small number of included
patients. A description of these limitations is required in discussion.
2) The baseline characteristics of the study population were not described in this study. The
patients’ characteristics can also influence their surgical outcomes. Please add the patients’
baseline characteristics (ex, Age, ASA, BMI, previous abdominal surgery history, etc)
3) Authors described “Preoperative prediction of severe cholecystitis (SC) is of great
significance, as the mortality and complication rate of SC is much higher that of chronic
cholecystitis. However, your study does not show surgical outcomes such as operation time,
intraoperative and postoperative complication, and mortality for each diagnosis. Please add the
surgical outcomes.
4) Recently, even in patients with severe cholecystitis, most cholecystectomy is performed
laparoscopically. However, in your study, most patients underwent open cholecystectomy. This
needs further explanation.
5) Authors showed that the GBWT, the percentage of neutrophils and WBC could be used to
differentiate APC, AGC, GC and CC, using ROC curve analysis. However, in order to confirm
the accuracy of this analyses, it is considered that multivariate analysis including other co-
variants that may have an effect is required.
Please review this paper.
user
Title: Prognostic clinical indexes for prediction of acute gangrenous cholecystitis and acute
purulent cholecystitis
Version: 4 Date: 16 Jul 2022
Reviewer's report:
Chen et al. performed retrospective study to identify preoperatively predictive factors for
severe cholecystitis, such as gangrenous cholecystitis, acute gangrenous cholecystitis, and acute
purulent cholecystitis. This is interesting subject, however, the description of manuscript is
immature. I have the following comments and questions.
1) This study has limitations as it is a retrospective study with a small number of included
patients. A description of these limitations is required in discussion.
2) The baseline characteristics of the study population were not described in this study. The
patients’ characteristics can also influence their surgical outcomes. Please add the patients’
baseline characteristics (ex, Age, ASA, BMI, previous abdominal surgery history, etc)
3) Authors described “Preoperative prediction of severe cholecystitis (SC) is of great
significance, as the mortality and complication rate of SC is much higher that of chronic
cholecystitis. However, your study does not show surgical outcomes such as operation time,
intraoperative and postoperative complication, and mortality for each diagnosis. Please add the
surgical outcomes.
4) Recently, even in patients with severe cholecystitis, most cholecystectomy is performed
laparoscopically. However, in your study, most patients underwent open cholecystectomy. This
needs further explanation.
5) Authors showed that the GBWT, the percentage of neutrophils and WBC could be used to
differentiate APC, AGC, GC and CC, using ROC curve analysis. However, in order to confirm
the accuracy of this analyses, it is considered that multivariate analysis including other co-
variants that may have an effect is required.
assistant