Title: Incidence and Risk factors of Fasting Hyperglycaemia Following First-attack Acute
Pancreatitis Before Discharge: A Retrospective Study
Version: 1 Date: 03 Nov 2022
Reviewer's report:
This is an interesting study highlighting one of the late complications of acute pancreatitis.
Considering that AP is a common disease with increasing incidence in most regions,
complications after the acute disease are relevant to study.
Title : “Following acute pancreatitis” indicates there is a follow up period. I suggest the authors
to change the title to better match the study.
Inclusion/exclusion criteria. Chronic pancreatitis is excluded but what about patients with
recurrent acute (but yet not chronic) pancreatitis? Where these patients included? Is it possible
to analyse if recurrent (i e not first attack) of acute pancreatitis was associated with IFG?
Methods: For definition of biliary etiology, please be more specific or refer to criteria. For
international criteria imaging of biliary stones (also in the gallbladder) is enough for definition
of biliary etiology even if laboratory markers are within normal limits.
FBG- please clarity in methods. Does this measurements refer to the day before discharge or after
discharge (as stated in text in results). “The average FPG values of the last two measurements”
were used. When were these to samplings done? Which time interval? Please clarify?
Mortality rate is 1% but is not specified in methods- is this in hospital mortality or after follow
up?
Describe how missing data was handled.
Why was the criteria “hospitalisation abdominal enhanced computed tomography (CT) results
within 48 h” set to within 48h? For most patients CT is not recommended and if it is needed
it is recommended after 5-7 days (according to Revised Atlanta classification and most recent
guidelines). How many patients did CT <48h?
Is it relevant to investigate associations between CTSI and FPG? Please motivate? How did the
radiologist train for the scoring? Are they used to the CTSI? I consider this variable not valid
and suggest that CTSI and the analysis of CTSI is excluded.  Still severity of acute pancreatitis
(where local complications are included) could be analysed if there are enough patients for the
analysis.
Figures and tables: Figure 2 A and B could be replaced by a table instead. I cannot see why
figure 3 is included, please motivate or exclude.Table text explaining the tables is missing. In
most tables "n" is missing. It should be possible to see "n" for  each parameter. I cannot fully
evaluate tables in its current form.
Discussion: In general, the discussion is too long. Especially some molecular details could be
less detailed in discussion.
Page 11, Line 123-124 “that people with AP are usually hospitalised for more than one week and
are no longer in a stress state when they are discharged from the hospital” I do not agree with
this. There are several large cohort studies indicating that patients with mild AP are discharged
within 3-5 days. Most patients are not totally recovered, but good enough to go home. Enhanced
CT is good for detection of pancreatic necrosis if performed after more than 3- 5 days. Initial CT
is not generally recommended in acute pancreatitis according to most gudielines Line 282 page
13- line 305 line 14 should be modified. It could also be excluded if the association between
CTSI and FPG is excluded from the manuscript as I suggest.
References: Please use correct original references. Example for Revised Atlanta classification
(Banks et al Pancreas 2013) and for CTSI (Balthazar et al., 1990) or the modified (MCTSI)
(Mortele et al 2004)
Languish/ editorial revision is needed for ex line 122 page 6, line 275 page 13 (Atlanta
classification not standard)
Title: Incidence and Risk factors of Fasting Hyperglycaemia Following First-attack Acute
Pancreatitis Before Discharge: A Retrospective Study
Version: 1 Date: 03 Nov 2022
Reviewer's report:
This is an interesting study highlighting one of the late complications of acute pancreatitis.
Considering that AP is a common disease with increasing incidence in most regions,
complications after the acute disease are relevant to study.
Title : “Following acute pancreatitis” indicates there is a follow up period. I suggest the authors
to change the title to better match the study.
Inclusion/exclusion criteria. Chronic pancreatitis is excluded but what about patients with
recurrent acute (but yet not chronic) pancreatitis? Where these patients included? Is it possible
to analyse if recurrent (i e not first attack) of acute pancreatitis was associated with IFG?
Methods: For definition of biliary etiology, please be more specific or refer to criteria. For
international criteria imaging of biliary stones (also in the gallbladder) is enough for definition
of biliary etiology even if laboratory markers are within normal limits.
FBG- please clarity in methods. Does this measurements refer to the day before discharge or after
discharge (as stated in text in results). “The average FPG values of the last two measurements”
were used. When were these to samplings done? Which time interval? Please clarify?
Mortality rate is 1% but is not specified in methods- is this in hospital mortality or after follow
up?
Describe how missing data was handled.
Why was the criteria “hospitalisation abdominal enhanced computed tomography (CT) results
within 48 h” set to within 48h? For most patients CT is not recommended and if it is needed
it is recommended after 5-7 days (according to Revised Atlanta classification and most recent
guidelines). How many patients did CT <48h?
Is it relevant to investigate associations between CTSI and FPG? Please motivate? How did the
radiologist train for the scoring? Are they used to the CTSI? I consider this variable not valid
and suggest that CTSI and the analysis of CTSI is excluded.  Still severity of acute pancreatitis
(where local complications are included) could be analysed if there are enough patients for the
analysis.
Figures and tables: Figure 2 A and B could be replaced by a table instead. I cannot see why
figure 3 is included, please motivate or exclude.Table text explaining the tables is missing. In
most tables "n" is missing. It should be possible to see "n" for  each parameter. I cannot fully
evaluate tables in its current form.
Discussion: In general, the discussion is too long. Especially some molecular details could be
less detailed in discussion.
Page 11, Line 123-124 “that people with AP are usually hospitalised for more than one week and
are no longer in a stress state when they are discharged from the hospital” I do not agree with
this. There are several large cohort studies indicating that patients with mild AP are discharged
within 3-5 days. Most patients are not totally recovered, but good enough to go home. Enhanced
CT is good for detection of pancreatic necrosis if performed after more than 3- 5 days. Initial CT
is not generally recommended in acute pancreatitis according to most gudielines Line 282 page
13- line 305 line 14 should be modified. It could also be excluded if the association between
CTSI and FPG is excluded from the manuscript as I suggest.
References: Please use correct original references. Example for Revised Atlanta classification
(Banks et al Pancreas 2013) and for CTSI (Balthazar et al., 1990) or the modified (MCTSI)
(Mortele et al 2004)
Languish/ editorial revision is needed for ex line 122 page 6, line 275 page 13 (Atlanta
classification not standard)
Please review this paper.
user
Title: Incidence and Risk factors of Fasting Hyperglycaemia Following First-attack Acute
Pancreatitis Before Discharge: A Retrospective Study
Version: 1 Date: 03 Nov 2022
Reviewer's report:
This is an interesting study highlighting one of the late complications of acute pancreatitis.
Considering that AP is a common disease with increasing incidence in most regions,
complications after the acute disease are relevant to study.
Title : “Following acute pancreatitis” indicates there is a follow up period. I suggest the authors
to change the title to better match the study.
Inclusion/exclusion criteria. Chronic pancreatitis is excluded but what about patients with
recurrent acute (but yet not chronic) pancreatitis? Where these patients included? Is it possible
to analyse if recurrent (i e not first attack) of acute pancreatitis was associated with IFG?
Methods: For definition of biliary etiology, please be more specific or refer to criteria. For
international criteria imaging of biliary stones (also in the gallbladder) is enough for definition
of biliary etiology even if laboratory markers are within normal limits.
FBG- please clarity in methods. Does this measurements refer to the day before discharge or after
discharge (as stated in text in results). “The average FPG values of the last two measurements”
were used. When were these to samplings done? Which time interval? Please clarify?
Mortality rate is 1% but is not specified in methods- is this in hospital mortality or after follow
up?
Describe how missing data was handled.
Why was the criteria “hospitalisation abdominal enhanced computed tomography (CT) results
within 48 h” set to within 48h? For most patients CT is not recommended and if it is needed
it is recommended after 5-7 days (according to Revised Atlanta classification and most recent
guidelines). How many patients did CT <48h?
Is it relevant to investigate associations between CTSI and FPG? Please motivate? How did the
radiologist train for the scoring? Are they used to the CTSI? I consider this variable not valid
and suggest that CTSI and the analysis of CTSI is excluded.  Still severity of acute pancreatitis
(where local complications are included) could be analysed if there are enough patients for the
analysis.
Figures and tables: Figure 2 A and B could be replaced by a table instead. I cannot see why
figure 3 is included, please motivate or exclude.Table text explaining the tables is missing. In
most tables "n" is missing. It should be possible to see "n" for  each parameter. I cannot fully
evaluate tables in its current form.
Discussion: In general, the discussion is too long. Especially some molecular details could be
less detailed in discussion.
Page 11, Line 123-124 “that people with AP are usually hospitalised for more than one week and
are no longer in a stress state when they are discharged from the hospital” I do not agree with
this. There are several large cohort studies indicating that patients with mild AP are discharged
within 3-5 days. Most patients are not totally recovered, but good enough to go home. Enhanced
CT is good for detection of pancreatic necrosis if performed after more than 3- 5 days. Initial CT
is not generally recommended in acute pancreatitis according to most gudielines Line 282 page
13- line 305 line 14 should be modified. It could also be excluded if the association between
CTSI and FPG is excluded from the manuscript as I suggest.
References: Please use correct original references. Example for Revised Atlanta classification
(Banks et al Pancreas 2013) and for CTSI (Balthazar et al., 1990) or the modified (MCTSI)
(Mortele et al 2004)
Languish/ editorial revision is needed for ex line 122 page 6, line 275 page 13 (Atlanta
classification not standard)
assistant