Reviewer's report
Title:Serum sodium based modification of the MELD does not improve
prediction of outcome in acute liver failure
Version: 2Date:22 January 2013
Reviewer: Heike Bantel
Reviewer's report:
In the present study the authors analyzed the performance of predictive scores in
ALF patients. The work comprises the KCC, MELD, UK-ELD and a newly
generated Na-MELD including serum sodium, replacing bilirubin. The authors
found the MELD to be superior to all other scores and a lack of prognostic value
for serum sodium or sodium modifications of existing scores. Since performance
of these prognostic systems was evaluated in 108 prospectively recruited
patients, the study is of high clinical relevance. The data is presented and
discussed appropriately. Although the authors present negative data, their
findings are relevant for the clinical management of ALF.
My suggestion would be to address some minor points:
1. Discussion of current publications on the topic would be important. There is
one recent work, where a lack of prognostic value for serum sodium in ALF is
implied: PMID: 23054946. Another paper discusses a completely novel score
including serum sodium: PMID: 22526269. A very recent work shows a survival
prediction of MELD-Na in waiting list patients: PMID: 23194386.
2. As the authors write: “ALF was diagnosed by significant liver dysfunction with
pathologically increased laboratory parameters (bilirubin, AST, ALT, AP,
#-GT)…” it would be quite informative to supply the applied limits for a
“pathological increase” as these limits have been discussed in the past and are
of some importance for clinical application of the presented data.
3. The quality of the pdf file for figure 1 and 3 is rather low and should be
improved.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Serum sodium based modification of the MELD does not improve
prediction of outcome in acute liver failure
Version: 2Date:22 January 2013
Reviewer: Heike Bantel
Reviewer's report:
In the present study the authors analyzed the performance of predictive scores in
ALF patients. The work comprises the KCC, MELD, UK-ELD and a newly
generated Na-MELD including serum sodium, replacing bilirubin. The authors
found the MELD to be superior to all other scores and a lack of prognostic value
for serum sodium or sodium modifications of existing scores. Since performance
of these prognostic systems was evaluated in 108 prospectively recruited
patients, the study is of high clinical relevance. The data is presented and
discussed appropriately. Although the authors present negative data, their
findings are relevant for the clinical management of ALF.
My suggestion would be to address some minor points:
1. Discussion of current publications on the topic would be important. There is
one recent work, where a lack of prognostic value for serum sodium in ALF is
implied: PMID: 23054946. Another paper discusses a completely novel score
including serum sodium: PMID: 22526269. A very recent work shows a survival
prediction of MELD-Na in waiting list patients: PMID: 23194386.
2. As the authors write: “ALF was diagnosed by significant liver dysfunction with
pathologically increased laboratory parameters (bilirubin, AST, ALT, AP,
#-GT)…” it would be quite informative to supply the applied limits for a
“pathological increase” as these limits have been discussed in the past and are
of some importance for clinical application of the presented data.
3. The quality of the pdf file for figure 1 and 3 is rather low and should be
improved.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Serum sodium based modification of the MELD does not improve
prediction of outcome in acute liver failure
Version: 2Date:22 January 2013
Reviewer: Heike Bantel
Reviewer's report:
In the present study the authors analyzed the performance of predictive scores in
ALF patients. The work comprises the KCC, MELD, UK-ELD and a newly
generated Na-MELD including serum sodium, replacing bilirubin. The authors
found the MELD to be superior to all other scores and a lack of prognostic value
for serum sodium or sodium modifications of existing scores. Since performance
of these prognostic systems was evaluated in 108 prospectively recruited
patients, the study is of high clinical relevance. The data is presented and
discussed appropriately. Although the authors present negative data, their
findings are relevant for the clinical management of ALF.
My suggestion would be to address some minor points:
1. Discussion of current publications on the topic would be important. There is
one recent work, where a lack of prognostic value for serum sodium in ALF is
implied: PMID: 23054946. Another paper discusses a completely novel score
including serum sodium: PMID: 22526269. A very recent work shows a survival
prediction of MELD-Na in waiting list patients: PMID: 23194386.
2. As the authors write: “ALF was diagnosed by significant liver dysfunction with
pathologically increased laboratory parameters (bilirubin, AST, ALT, AP,
#-GT)…” it would be quite informative to supply the applied limits for a
“pathological increase” as these limits have been discussed in the past and are
of some importance for clinical application of the presented data.
3. The quality of the pdf file for figure 1 and 3 is rather low and should be
improved.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
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