Reviewer's report
Title:vasopressin V2-receptor antagonists in cirrhosis patients with ascites: A
systemic review of randomized controlled trials
Version:4Date:13 April 2015
Reviewer: Elliot B Tapper
Reviewer's report:
COMPULSORY REVISIONS
1. English: The prose must be completely rewritten but is sufficiently clear for
review.
2. The outcomes must be specified and narrowed.
3. The adverse events must be defined
4. Several graphs must be deleted
By section
Introduction:
The authors cite rapid correction of hyponatremia as the complication of vaptans.
In practice, this is more of a theoretical risk. While careful monitoring for speed of
correction is needed/obligatory, it is a given and thus cerebral injury is rare; the
true limits of the vaptan’s clinical application are thirst, hyperglycemia and cost
precluding discharge on the medication. This, of course, is aside from the fact
that vaptans have a black box warning for liver injury (as seen in the trials of
vaptans for PCKD). These are the contemporary concerns that the introduction
must address.
Methods
The start date for the search is not given
The outcome of the study is not specified. Yet, 5 papers were excluded for this
reason (did not report outcome of interest). The authors mention several primary
outcomes in a later paragraph (at least one of which would be discussed in any
RCT of vaptans). The authors should specify a primary outcome and which
outcomes were secondary. The specific serious adverse events are not
explained in the methods or the results section.
Results:
What is the focus? The reader will be overwhelmed by graph after graph and the
authors have not articulated the reason for this volume of data. For example,
abdominal girth (fig 2b) is of limited value when weight is presented; the
difference between figure 3a and 3b is not explained and 3c appears to show
changes in the first 7 days while 3b shows days 1-14; serious adverse events are
ok but it is not clear why hypernatremia is singled out - is it not, by itself, a
serious adverse event. Most outcomes are vague. Essentially, the authors have
performed the steps of meta-analysis without defining the terms they are
analyzing.
The prose in the results section is at times very difficult to understand and must
be rewritten.
Discussion
Unfortunately the english precludes a thorough review of this section. The
authors should rewrite every paragraph save for the first.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:vasopressin V2-receptor antagonists in cirrhosis patients with ascites: A
systemic review of randomized controlled trials
Version:4Date:13 April 2015
Reviewer: Elliot B Tapper
Reviewer's report:
COMPULSORY REVISIONS
1. English: The prose must be completely rewritten but is sufficiently clear for
review.
2. The outcomes must be specified and narrowed.
3. The adverse events must be defined
4. Several graphs must be deleted
By section
Introduction:
The authors cite rapid correction of hyponatremia as the complication of vaptans.
In practice, this is more of a theoretical risk. While careful monitoring for speed of
correction is needed/obligatory, it is a given and thus cerebral injury is rare; the
true limits of the vaptan’s clinical application are thirst, hyperglycemia and cost
precluding discharge on the medication. This, of course, is aside from the fact
that vaptans have a black box warning for liver injury (as seen in the trials of
vaptans for PCKD). These are the contemporary concerns that the introduction
must address.
Methods
The start date for the search is not given
The outcome of the study is not specified. Yet, 5 papers were excluded for this
reason (did not report outcome of interest). The authors mention several primary
outcomes in a later paragraph (at least one of which would be discussed in any
RCT of vaptans). The authors should specify a primary outcome and which
outcomes were secondary. The specific serious adverse events are not
explained in the methods or the results section.
Results:
What is the focus? The reader will be overwhelmed by graph after graph and the
authors have not articulated the reason for this volume of data. For example,
abdominal girth (fig 2b) is of limited value when weight is presented; the
difference between figure 3a and 3b is not explained and 3c appears to show
changes in the first 7 days while 3b shows days 1-14; serious adverse events are
ok but it is not clear why hypernatremia is singled out - is it not, by itself, a
serious adverse event. Most outcomes are vague. Essentially, the authors have
performed the steps of meta-analysis without defining the terms they are
analyzing.
The prose in the results section is at times very difficult to understand and must
be rewritten.
Discussion
Unfortunately the english precludes a thorough review of this section. The
authors should rewrite every paragraph save for the first.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:vasopressin V2-receptor antagonists in cirrhosis patients with ascites: A
systemic review of randomized controlled trials
Version:4Date:13 April 2015
Reviewer: Elliot B Tapper
Reviewer's report:
COMPULSORY REVISIONS
1. English: The prose must be completely rewritten but is sufficiently clear for
review.
2. The outcomes must be specified and narrowed.
3. The adverse events must be defined
4. Several graphs must be deleted
By section
Introduction:
The authors cite rapid correction of hyponatremia as the complication of vaptans.
In practice, this is more of a theoretical risk. While careful monitoring for speed of
correction is needed/obligatory, it is a given and thus cerebral injury is rare; the
true limits of the vaptan’s clinical application are thirst, hyperglycemia and cost
precluding discharge on the medication. This, of course, is aside from the fact
that vaptans have a black box warning for liver injury (as seen in the trials of
vaptans for PCKD). These are the contemporary concerns that the introduction
must address.
Methods
The start date for the search is not given
The outcome of the study is not specified. Yet, 5 papers were excluded for this
reason (did not report outcome of interest). The authors mention several primary
outcomes in a later paragraph (at least one of which would be discussed in any
RCT of vaptans). The authors should specify a primary outcome and which
outcomes were secondary. The specific serious adverse events are not
explained in the methods or the results section.
Results:
What is the focus? The reader will be overwhelmed by graph after graph and the
authors have not articulated the reason for this volume of data. For example,
abdominal girth (fig 2b) is of limited value when weight is presented; the
difference between figure 3a and 3b is not explained and 3c appears to show
changes in the first 7 days while 3b shows days 1-14; serious adverse events are
ok but it is not clear why hypernatremia is singled out - is it not, by itself, a
serious adverse event. Most outcomes are vague. Essentially, the authors have
performed the steps of meta-analysis without defining the terms they are
analyzing.
The prose in the results section is at times very difficult to understand and must
be rewritten.
Discussion
Unfortunately the english precludes a thorough review of this section. The
authors should rewrite every paragraph save for the first.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
assistant