Reviewer's report
Title:Meta-analyses of Fibrotest diagnostic value in chronic liver disease
Version: 2Date:29 July 2007
Reviewer: giada Sebastiani
Reviewer's report:
General
The manuscript is about two meta-analysis regarding performance and
diagnostic value of Fibrotest, that is the most studied non-invasive biomarker for
liver fibrosis. The paper is well written but some issues should be addressed
before publication.
-------------------------------------------------------------------------------
Major Compulsory Revisions (that the author must respond to before a decision
on publication can be reached)
1) It may be very useful to know how many patients have been excluded
because of Fibrotest inefficiency (Gilbert's syndrome, haemolysis). Since data
are big, this can give an idea of Fibrotest failure in the various studies.
2) Individual data showed in Table 2 were available for 3282 cases, who then
constituted the integrated database. It should be specified how many of them
come from independent studies and from not independent/mixed studies.
3) in the discussion the authors state "one limitation of the study is that the
number of studies and patients in non HCV related diseases is smaller than
those in HCV". It should be clearly added that another limitation is that there are
very few independent studies in other chronic liver diseases (1 for HBV, 1 for
NAFLD and none for ALD).
4) In the discussion the authors state that a liver biopsy of 15mm has an AUROC
of 0.82. It should be added that, according to recent data from the pathologists,
gold standard liver biopsy should be bigger, and this might in fact lead to a higher
accuracy of liver biopsy (see Guido M, Rugge M. Liver biopsy sampling in
chronic viral hepatitis. Semin Liver Dis 2004; 24: 89-97). The sentence "the
median biopsy lenght in tertiary centers" must be justified with references,
otherwise is arbitrary.
5) the authors may want to comment in the discussion about the statistically
significant p-values reported in the Tables.
-------------------------------------------------------------------------------
Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
1) reference [2] is written in a wrong position in the Background.
2) Table 1: Colletta study [27] was conducted on NALT and not PNALT cases.
This must be changed.
3) there are some typo errors in the references section.
------------------------------------------------------------------------------
Discretionary Revisions (which the author can choose to ignore)
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Meta-analyses of Fibrotest diagnostic value in chronic liver disease
Version: 2Date:29 July 2007
Reviewer: giada Sebastiani
Reviewer's report:
General
The manuscript is about two meta-analysis regarding performance and
diagnostic value of Fibrotest, that is the most studied non-invasive biomarker for
liver fibrosis. The paper is well written but some issues should be addressed
before publication.
-------------------------------------------------------------------------------
Major Compulsory Revisions (that the author must respond to before a decision
on publication can be reached)
1) It may be very useful to know how many patients have been excluded
because of Fibrotest inefficiency (Gilbert's syndrome, haemolysis). Since data
are big, this can give an idea of Fibrotest failure in the various studies.
2) Individual data showed in Table 2 were available for 3282 cases, who then
constituted the integrated database. It should be specified how many of them
come from independent studies and from not independent/mixed studies.
3) in the discussion the authors state "one limitation of the study is that the
number of studies and patients in non HCV related diseases is smaller than
those in HCV". It should be clearly added that another limitation is that there are
very few independent studies in other chronic liver diseases (1 for HBV, 1 for
NAFLD and none for ALD).
4) In the discussion the authors state that a liver biopsy of 15mm has an AUROC
of 0.82. It should be added that, according to recent data from the pathologists,
gold standard liver biopsy should be bigger, and this might in fact lead to a higher
accuracy of liver biopsy (see Guido M, Rugge M. Liver biopsy sampling in
chronic viral hepatitis. Semin Liver Dis 2004; 24: 89-97). The sentence "the
median biopsy lenght in tertiary centers" must be justified with references,
otherwise is arbitrary.
5) the authors may want to comment in the discussion about the statistically
significant p-values reported in the Tables.
-------------------------------------------------------------------------------
Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
1) reference [2] is written in a wrong position in the Background.
2) Table 1: Colletta study [27] was conducted on NALT and not PNALT cases.
This must be changed.
3) there are some typo errors in the references section.
------------------------------------------------------------------------------
Discretionary Revisions (which the author can choose to ignore)
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Meta-analyses of Fibrotest diagnostic value in chronic liver disease
Version: 2Date:29 July 2007
Reviewer: giada Sebastiani
Reviewer's report:
General
The manuscript is about two meta-analysis regarding performance and
diagnostic value of Fibrotest, that is the most studied non-invasive biomarker for
liver fibrosis. The paper is well written but some issues should be addressed
before publication.
-------------------------------------------------------------------------------
Major Compulsory Revisions (that the author must respond to before a decision
on publication can be reached)
1) It may be very useful to know how many patients have been excluded
because of Fibrotest inefficiency (Gilbert's syndrome, haemolysis). Since data
are big, this can give an idea of Fibrotest failure in the various studies.
2) Individual data showed in Table 2 were available for 3282 cases, who then
constituted the integrated database. It should be specified how many of them
come from independent studies and from not independent/mixed studies.
3) in the discussion the authors state "one limitation of the study is that the
number of studies and patients in non HCV related diseases is smaller than
those in HCV". It should be clearly added that another limitation is that there are
very few independent studies in other chronic liver diseases (1 for HBV, 1 for
NAFLD and none for ALD).
4) In the discussion the authors state that a liver biopsy of 15mm has an AUROC
of 0.82. It should be added that, according to recent data from the pathologists,
gold standard liver biopsy should be bigger, and this might in fact lead to a higher
accuracy of liver biopsy (see Guido M, Rugge M. Liver biopsy sampling in
chronic viral hepatitis. Semin Liver Dis 2004; 24: 89-97). The sentence "the
median biopsy lenght in tertiary centers" must be justified with references,
otherwise is arbitrary.
5) the authors may want to comment in the discussion about the statistically
significant p-values reported in the Tables.
-------------------------------------------------------------------------------
Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
1) reference [2] is written in a wrong position in the Background.
2) Table 1: Colletta study [27] was conducted on NALT and not PNALT cases.
This must be changed.
3) there are some typo errors in the references section.
------------------------------------------------------------------------------
Discretionary Revisions (which the author can choose to ignore)
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant