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: 0 Date: 06 Aug 2018  
 
Reviewer: Mathie P. G. Leers  
 
Reviewer's report:  
 
This paper provides a well described retrospective study for the determination of the association 
between macrocytic anemia and the severity of li ver impairment in patients with Hepatitis B 
virus -related decompensated cirrhosis. This study exploits the combination of routine 
hemocytometric data, patients characteristics, biochemical data and a score developed for the 
prediction of the short -term mor tality of end -stage liver disease (the so -called MELD -score). I 
agree with the authors that a major shortcoming of this investigation is the fact that no data were 
included about vitamine B12, folate and reticulocyte count. This could had made the study mu ch 
stronger. I have no major criticisms, only a few minor ones.  
 
 
 
1. On page 3, rule 26, the authors stated that anemia is always accompanied by erythrocyte 
abnormalities. This is not true, because a major part of the anemie is normocytic and 
shows no eryth rocyte abnormalities. Please comment on this.  
 
 
2. On page 5, rule 34 smoking is used twice in one sentence. Please change this  
 
 
3. On page 6, rule 58 the authors stated that patients with macrocytic anemia had higher 
levels of total cholesterol. However, in table 1 it was shown that the total cholesterol in 
patients with macrocytic anemia is lower than that of normocytic or microcytic anemia -
patients  
 
 
4. On page 7, rule 6, the authors stated that there was no significant difference for occurence 
of diabetes be tween the 3 different groups (macro -, normo - and microcytic anemia) while 
in table 1 a P -value of 0.026 was found (thus <0.05)  
 
 
5. The numbers of both figures are switched.  Figure 1 (patient selection) and Figure 2 
(MELD score in the 3 different groups) a re now numbered as figure 2 and figure 1, 
respectively.  
 
 
Are the methods appropriate and well described?  
If not, please spe cify 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 manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy 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 fro m 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 t hat 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 appl ied 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 understan d that my name will be included 
on my report to the authors and, if 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 publis hed. 
 
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: 0 Date: 06 Aug 2018  
 
Reviewer: Mathie P. G. Leers  
 
Reviewer's report:  
 
This paper provides a well described retrospective study for the determination of the association 
between macrocytic anemia and the severity of li ver impairment in patients with Hepatitis B 
virus -related decompensated cirrhosis. This study exploits the combination of routine 
hemocytometric data, patients characteristics, biochemical data and a score developed for the 
prediction of the short -term mor tality of end -stage liver disease (the so -called MELD -score). I 
agree with the authors that a major shortcoming of this investigation is the fact that no data were 
included about vitamine B12, folate and reticulocyte count. This could had made the study mu ch 
stronger. I have no major criticisms, only a few minor ones.  
 
 
 
1. On page 3, rule 26, the authors stated that anemia is always accompanied by erythrocyte 
abnormalities. This is not true, because a major part of the anemie is normocytic and 
shows no eryth rocyte abnormalities. Please comment on this.  
 
 
2. On page 5, rule 34 smoking is used twice in one sentence. Please change this  
 
 
3. On page 6, rule 58 the authors stated that patients with macrocytic anemia had higher 
levels of total cholesterol. However, in table 1 it was shown that the total cholesterol in 
patients with macrocytic anemia is lower than that of normocytic or microcytic anemia -
patients  
 
 
4. On page 7, rule 6, the authors stated that there was no significant difference for occurence 
of diabetes be tween the 3 different groups (macro -, normo - and microcytic anemia) while 
in table 1 a P -value of 0.026 was found (thus <0.05)  
 
 
5. The numbers of both figures are switched.  Figure 1 (patient selection) and Figure 2 
(MELD score in the 3 different groups) a re now numbered as figure 2 and figure 1, 
respectively.  
 
 
Are the methods appropriate and well described?  
If not, please spe cify 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 manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy 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 fro m 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 t hat 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 appl ied 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 understan d that my name will be included 
on my report to the authors and, if 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 publis hed. 
 
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: 0 Date: 06 Aug 2018  
 
Reviewer: Mathie P. G. Leers  
 
Reviewer's report:  
 
This paper provides a well described retrospective study for the determination of the association 
between macrocytic anemia and the severity of li ver impairment in patients with Hepatitis B 
virus -related decompensated cirrhosis. This study exploits the combination of routine 
hemocytometric data, patients characteristics, biochemical data and a score developed for the 
prediction of the short -term mor tality of end -stage liver disease (the so -called MELD -score). I 
agree with the authors that a major shortcoming of this investigation is the fact that no data were 
included about vitamine B12, folate and reticulocyte count. This could had made the study mu ch 
stronger. I have no major criticisms, only a few minor ones.  
 
 
 
1. On page 3, rule 26, the authors stated that anemia is always accompanied by erythrocyte 
abnormalities. This is not true, because a major part of the anemie is normocytic and 
shows no eryth rocyte abnormalities. Please comment on this.  
 
 
2. On page 5, rule 34 smoking is used twice in one sentence. Please change this  
 
 
3. On page 6, rule 58 the authors stated that patients with macrocytic anemia had higher 
levels of total cholesterol. However, in table 1 it was shown that the total cholesterol in 
patients with macrocytic anemia is lower than that of normocytic or microcytic anemia -
patients  
 
 
4. On page 7, rule 6, the authors stated that there was no significant difference for occurence 
of diabetes be tween the 3 different groups (macro -, normo - and microcytic anemia) while 
in table 1 a P -value of 0.026 was found (thus <0.05)  
 
 
5. The numbers of both figures are switched.  Figure 1 (patient selection) and Figure 2 
(MELD score in the 3 different groups) a re now numbered as figure 2 and figure 1, 
respectively.  
 
 
Are the methods appropriate and well described?  
If not, please spe cify 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 manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy 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 fro m 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 t hat 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 appl ied 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 understan d that my name will be included 
on my report to the authors and, if 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 publis hed. 
 
I agree to the open peer review policy of the journal  
assistant