Reviewer ’s report  
 
Title: Fibrosis -4 index at diagnosis is associated with all -cause mortality in patients with 
microscopic polyangiitis and granulomatosis with polyangiitis  
 
Version: 0 Date: 14 Nov 2018  
 
Reviewer: Ronald Falk  
 
Reviewer's report:  
 
This study is interesting in that the score has not been applied to all -cause mortality in vasc ulitis. 
It is potentially of interest.  
1. Much more analysis needs to be done, including multivariate analysis with a number of other 
variables, to determine why this score may have any merit in vasculitis. Is a transaminase 
causing the score to be abnorma l? If so, which one? Is a lowered platelet count altering the 
score? What other variables, including inflammatory markers, could be impugned? In other 
words, multivariate analysis with each part of this score and will all sorts of other variables 
that one can imagine, needs to be carefully conducted.  
 
2. The role of medications on this score, especially cyclophosphamide and azathioprine that 
may lower the platelet count, has to be excluded as the cause of alteration of this score.  
 
3. This is an unusual popul ation in that women are more commonly involved than men. Is that 
true of other populations in your country? If not, why do you think this population is female -
dominant?  
 
4. How many biopsies were done? What percentage of this population had biopsy -proven 
disease? In which organ was the biopsy obtained? Said differently, a much more thorough 
description of this unusual population needs to be done.  
 
5. Why were over 10% of the patients ANCA negative? If an analysis is performed in which 
only patients who had a positive PR3 or MPO ANCA were studied, or a P -ANCA in which 
the ANA is negative, do you come up with a different outcome/result?  
Are the methods appropriate and well d escribed?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
Are the conclusions dra wn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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 from an  
organisation t hat 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 that may in any way gain or lose  
financially from the publication of this manuscript, e ither 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 applied for patents rel ating 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 compet ing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscrip t is accepted for 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 included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Fibrosis -4 index at diagnosis is associated with all -cause mortality in patients with 
microscopic polyangiitis and granulomatosis with polyangiitis  
 
Version: 0 Date: 14 Nov 2018  
 
Reviewer: Ronald Falk  
 
Reviewer's report:  
 
This study is interesting in that the score has not been applied to all -cause mortality in vasc ulitis. 
It is potentially of interest.  
1. Much more analysis needs to be done, including multivariate analysis with a number of other 
variables, to determine why this score may have any merit in vasculitis. Is a transaminase 
causing the score to be abnorma l? If so, which one? Is a lowered platelet count altering the 
score? What other variables, including inflammatory markers, could be impugned? In other 
words, multivariate analysis with each part of this score and will all sorts of other variables 
that one can imagine, needs to be carefully conducted.  
 
2. The role of medications on this score, especially cyclophosphamide and azathioprine that 
may lower the platelet count, has to be excluded as the cause of alteration of this score.  
 
3. This is an unusual popul ation in that women are more commonly involved than men. Is that 
true of other populations in your country? If not, why do you think this population is female -
dominant?  
 
4. How many biopsies were done? What percentage of this population had biopsy -proven 
disease? In which organ was the biopsy obtained? Said differently, a much more thorough 
description of this unusual population needs to be done.  
 
5. Why were over 10% of the patients ANCA negative? If an analysis is performed in which 
only patients who had a positive PR3 or MPO ANCA were studied, or a P -ANCA in which 
the ANA is negative, do you come up with a different outcome/result?  
Are the methods appropriate and well d escribed?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
Are the conclusions dra wn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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 from an  
organisation t hat 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 that may in any way gain or lose  
financially from the publication of this manuscript, e ither 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 applied for patents rel ating 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 compet ing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscrip t is accepted for 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 included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Fibrosis -4 index at diagnosis is associated with all -cause mortality in patients with 
microscopic polyangiitis and granulomatosis with polyangiitis  
 
Version: 0 Date: 14 Nov 2018  
 
Reviewer: Ronald Falk  
 
Reviewer's report:  
 
This study is interesting in that the score has not been applied to all -cause mortality in vasc ulitis. 
It is potentially of interest.  
1. Much more analysis needs to be done, including multivariate analysis with a number of other 
variables, to determine why this score may have any merit in vasculitis. Is a transaminase 
causing the score to be abnorma l? If so, which one? Is a lowered platelet count altering the 
score? What other variables, including inflammatory markers, could be impugned? In other 
words, multivariate analysis with each part of this score and will all sorts of other variables 
that one can imagine, needs to be carefully conducted.  
 
2. The role of medications on this score, especially cyclophosphamide and azathioprine that 
may lower the platelet count, has to be excluded as the cause of alteration of this score.  
 
3. This is an unusual popul ation in that women are more commonly involved than men. Is that 
true of other populations in your country? If not, why do you think this population is female -
dominant?  
 
4. How many biopsies were done? What percentage of this population had biopsy -proven 
disease? In which organ was the biopsy obtained? Said differently, a much more thorough 
description of this unusual population needs to be done.  
 
5. Why were over 10% of the patients ANCA negative? If an analysis is performed in which 
only patients who had a positive PR3 or MPO ANCA were studied, or a P -ANCA in which 
the ANA is negative, do you come up with a different outcome/result?  
Are the methods appropriate and well d escribed?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
Are the conclusions dra wn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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 from an  
organisation t hat 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 that may in any way gain or lose  
financially from the publication of this manuscript, e ither 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 applied for patents rel ating 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 compet ing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscrip t is accepted for 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 included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant