Title: Prognostic Value of the International Normalized Ratio to Albumin Ratio in Acute
Pancreatitis: Insights from MIMIC-IV Database
Version: 1 Date: 04 Jun 2025
Reviewer's report:
Fang et al. investigates the prognostic utility of PTAR (International Normalized Ratio to
Albumin Ratio) in predicting mortality among 459 ICU patients with acute pancreatitis (AP)
from the MIMIC-IV database. This study elevated PTAR independently predicted increased
all-cause mortality at 7, 14, 21, 28, 90, and 365 days post-admission, even after adjusting for
confounders (HRs: 2.31–4.91). Although the conclusion is interesting, there are some concerns
which should be addressed.
1. The analysis of PTAR’s performance across AP subtypes or severity grades are lacked.
2. Cutoff point and AUCs require external validation in independent cohorts.
3. Abstract states 456 patients were enrolled, Introduction/Methods state 459. This discrepancy
undermines data transparency and reproducibility.
4. No comparison to AP-specific scores is included, making clinical utility claims
unsubstantiated.
5.AP patients, especially survivors, may die from causes unrelated to AP. The study uses all-
cause mortality as the endpoint is not appropriate.
6. The conclusion that PTAR is "more precise" than alternatives is unsupported—it only matched
SOFA's AUC, not surpassed it.
Title: Prognostic Value of the International Normalized Ratio to Albumin Ratio in Acute
Pancreatitis: Insights from MIMIC-IV Database
Version: 1 Date: 04 Jun 2025
Reviewer's report:
Fang et al. investigates the prognostic utility of PTAR (International Normalized Ratio to
Albumin Ratio) in predicting mortality among 459 ICU patients with acute pancreatitis (AP)
from the MIMIC-IV database. This study elevated PTAR independently predicted increased
all-cause mortality at 7, 14, 21, 28, 90, and 365 days post-admission, even after adjusting for
confounders (HRs: 2.31–4.91). Although the conclusion is interesting, there are some concerns
which should be addressed.
1. The analysis of PTAR’s performance across AP subtypes or severity grades are lacked.
2. Cutoff point and AUCs require external validation in independent cohorts.
3. Abstract states 456 patients were enrolled, Introduction/Methods state 459. This discrepancy
undermines data transparency and reproducibility.
4. No comparison to AP-specific scores is included, making clinical utility claims
unsubstantiated.
5.AP patients, especially survivors, may die from causes unrelated to AP. The study uses all-
cause mortality as the endpoint is not appropriate.
6. The conclusion that PTAR is "more precise" than alternatives is unsupported—it only matched
SOFA's AUC, not surpassed it.
Please review this paper.
user
Title: Prognostic Value of the International Normalized Ratio to Albumin Ratio in Acute
Pancreatitis: Insights from MIMIC-IV Database
Version: 1 Date: 04 Jun 2025
Reviewer's report:
Fang et al. investigates the prognostic utility of PTAR (International Normalized Ratio to
Albumin Ratio) in predicting mortality among 459 ICU patients with acute pancreatitis (AP)
from the MIMIC-IV database. This study elevated PTAR independently predicted increased
all-cause mortality at 7, 14, 21, 28, 90, and 365 days post-admission, even after adjusting for
confounders (HRs: 2.31–4.91). Although the conclusion is interesting, there are some concerns
which should be addressed.
1. The analysis of PTAR’s performance across AP subtypes or severity grades are lacked.
2. Cutoff point and AUCs require external validation in independent cohorts.
3. Abstract states 456 patients were enrolled, Introduction/Methods state 459. This discrepancy
undermines data transparency and reproducibility.
4. No comparison to AP-specific scores is included, making clinical utility claims
unsubstantiated.
5.AP patients, especially survivors, may die from causes unrelated to AP. The study uses all-
cause mortality as the endpoint is not appropriate.
6. The conclusion that PTAR is "more precise" than alternatives is unsupported—it only matched
SOFA's AUC, not surpassed it.
assistant