Reviewer’s report
Title: 
Association between plasma level of superoxide dismutase and survival of
patients with acute-on-chronic liver failure
Version: 
1 
Date: 
23 Nov 2021
Reviewer's report:
The association between oxidative stress and survival analysis in patients with
Acute-On-Chronic Liver disease is an interesting topic. I read with interest this
manuscript by Zhen Tian et al. 
The manuscript is well written. The results section and discussion section are too
long. 
The authors showed that the Plasma Superoxyde Dismutase level, measured at
hospital admission can be used to identify patients with ACLF at high risk of
death. In addition, the combination SOD level and MELD score predicts the
outcome. 
The authors, with their results, must convince the authors of the interest of such
a dosage in the management of the patients with ACLF. For example, the
superiority of this combination SOD level and MELD score compared to the
number of organ failures for a registration on the waiting list of LT. 
There are some defects (in particularly in the methodology and in the results
section) in this manuscript as follows: 
1) The authors use the APASL criteria for ACLF diagnosis. This choice limits
the impact of the results on the european and american readers. I invite the
authors to use European / American definitions (Moreau Gastroenterology
2013). In addition, no patient information are available : cause of cirrhosis,
hospitalization reason, clif sofa score, Meld score for cirrhosis patients, previous
complications (bleeding, infection, ascites…), organ failure ? in which unit are
patients hospitalized ? 
2) Blood sample were collected at admission and 14 days after hospital
admission. Why chose 14 days ? Please explain. how many patients did not get
the second sample ? Does the second dosage change the results of the research?
3) The authors performed a cohort study of adult LT including 124 patients with
ACLF, 30 cirrhotic patients and 30 Healthly controls (Table 1). In the method
section and Line 50-55 the authors compare ACLF patients and ALF patients.
Who are these patients ? There is no information about these patients in the table
1. 
Minor Concerns: 
The introduction section is clear. Please delete the sentence or modify the
sentence: lines 40-46 (introduction section). I agree that there are some scoring
systems for assessing the ACLF severity and the prognostic of patients with
ACLF. However, the best system is the CLIF-SOFA score. 
Please delete the standard formula of MELD score. Today, the reader knows it. 
The results section and discussion section are too long. 
Line 54-56 (results section): it is a commentary. Please delete these sentences
from the results section. In addition the sentence "about MELD score > 25 in
patients with ALF" and "association of plasma SOD levels …" are not results but
more comments. Put it in the discussion paragraph.
Some abbreviations have been used in the text and in the Tables. However, the
abbreviations used although explained in the manuscript are not the international
abbreviations. can you correct this?
(Ex fibrinogen : Fb instead of FIB, Prothrombin time: PT instead of PTA)….
There are some typographical errors. Please check and change them. 
Publons Reviewer Recognition
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find the details of processing in Publons’ privacy policy
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No
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 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 that 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 applied 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
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Association between plasma level of superoxide dismutase and survival of
patients with acute-on-chronic liver failure
Version: 
1 
Date: 
23 Nov 2021
Reviewer's report:
The association between oxidative stress and survival analysis in patients with
Acute-On-Chronic Liver disease is an interesting topic. I read with interest this
manuscript by Zhen Tian et al. 
The manuscript is well written. The results section and discussion section are too
long. 
The authors showed that the Plasma Superoxyde Dismutase level, measured at
hospital admission can be used to identify patients with ACLF at high risk of
death. In addition, the combination SOD level and MELD score predicts the
outcome. 
The authors, with their results, must convince the authors of the interest of such
a dosage in the management of the patients with ACLF. For example, the
superiority of this combination SOD level and MELD score compared to the
number of organ failures for a registration on the waiting list of LT. 
There are some defects (in particularly in the methodology and in the results
section) in this manuscript as follows: 
1) The authors use the APASL criteria for ACLF diagnosis. This choice limits
the impact of the results on the european and american readers. I invite the
authors to use European / American definitions (Moreau Gastroenterology
2013). In addition, no patient information are available : cause of cirrhosis,
hospitalization reason, clif sofa score, Meld score for cirrhosis patients, previous
complications (bleeding, infection, ascites…), organ failure ? in which unit are
patients hospitalized ? 
2) Blood sample were collected at admission and 14 days after hospital
admission. Why chose 14 days ? Please explain. how many patients did not get
the second sample ? Does the second dosage change the results of the research?
3) The authors performed a cohort study of adult LT including 124 patients with
ACLF, 30 cirrhotic patients and 30 Healthly controls (Table 1). In the method
section and Line 50-55 the authors compare ACLF patients and ALF patients.
Who are these patients ? There is no information about these patients in the table
1. 
Minor Concerns: 
The introduction section is clear. Please delete the sentence or modify the
sentence: lines 40-46 (introduction section). I agree that there are some scoring
systems for assessing the ACLF severity and the prognostic of patients with
ACLF. However, the best system is the CLIF-SOFA score. 
Please delete the standard formula of MELD score. Today, the reader knows it. 
The results section and discussion section are too long. 
Line 54-56 (results section): it is a commentary. Please delete these sentences
from the results section. In addition the sentence "about MELD score > 25 in
patients with ALF" and "association of plasma SOD levels …" are not results but
more comments. Put it in the discussion paragraph.
Some abbreviations have been used in the text and in the Tables. However, the
abbreviations used although explained in the manuscript are not the international
abbreviations. can you correct this?
(Ex fibrinogen : Fb instead of FIB, Prothrombin time: PT instead of PTA)….
There are some typographical errors. Please check and change them. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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 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 that 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 applied 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
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Association between plasma level of superoxide dismutase and survival of
patients with acute-on-chronic liver failure
Version: 
1 
Date: 
23 Nov 2021
Reviewer's report:
The association between oxidative stress and survival analysis in patients with
Acute-On-Chronic Liver disease is an interesting topic. I read with interest this
manuscript by Zhen Tian et al. 
The manuscript is well written. The results section and discussion section are too
long. 
The authors showed that the Plasma Superoxyde Dismutase level, measured at
hospital admission can be used to identify patients with ACLF at high risk of
death. In addition, the combination SOD level and MELD score predicts the
outcome. 
The authors, with their results, must convince the authors of the interest of such
a dosage in the management of the patients with ACLF. For example, the
superiority of this combination SOD level and MELD score compared to the
number of organ failures for a registration on the waiting list of LT. 
There are some defects (in particularly in the methodology and in the results
section) in this manuscript as follows: 
1) The authors use the APASL criteria for ACLF diagnosis. This choice limits
the impact of the results on the european and american readers. I invite the
authors to use European / American definitions (Moreau Gastroenterology
2013). In addition, no patient information are available : cause of cirrhosis,
hospitalization reason, clif sofa score, Meld score for cirrhosis patients, previous
complications (bleeding, infection, ascites…), organ failure ? in which unit are
patients hospitalized ? 
2) Blood sample were collected at admission and 14 days after hospital
admission. Why chose 14 days ? Please explain. how many patients did not get
the second sample ? Does the second dosage change the results of the research?
3) The authors performed a cohort study of adult LT including 124 patients with
ACLF, 30 cirrhotic patients and 30 Healthly controls (Table 1). In the method
section and Line 50-55 the authors compare ACLF patients and ALF patients.
Who are these patients ? There is no information about these patients in the table
1. 
Minor Concerns: 
The introduction section is clear. Please delete the sentence or modify the
sentence: lines 40-46 (introduction section). I agree that there are some scoring
systems for assessing the ACLF severity and the prognostic of patients with
ACLF. However, the best system is the CLIF-SOFA score. 
Please delete the standard formula of MELD score. Today, the reader knows it. 
The results section and discussion section are too long. 
Line 54-56 (results section): it is a commentary. Please delete these sentences
from the results section. In addition the sentence "about MELD score > 25 in
patients with ALF" and "association of plasma SOD levels …" are not results but
more comments. Put it in the discussion paragraph.
Some abbreviations have been used in the text and in the Tables. However, the
abbreviations used although explained in the manuscript are not the international
abbreviations. can you correct this?
(Ex fibrinogen : Fb instead of FIB, Prothrombin time: PT instead of PTA)….
There are some typographical errors. Please check and change them. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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 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 that 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 applied 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
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant