Title: Lower serum chloride concentrations are associated with increased risk of mortality in
critically ill cirrhotic patients: an analysis of the MIMIC-III database
Version: 2 Date: 26 Jan 2021
Reviewer's report:
The authors have done a nice job of editing the original manuscript. They have addressed the
comments appropriately and the manuscript is much improved.
Discussion: first paragraph 4th sentence. I believe there is a typo. It states that the mortality
rate is lower in patients with hypochloremia when the mortality rate was higher in patients with
hypochloremia.
The paragraph discussing the potential relationship of hypochloremia and mortality does not
discuss that chicken or the egg difficulty with this. Hypochloremia may be the result of the
progressive course of cirrhosis and may be an important biomarker of this progression. It
may also exacerbate this course. An observational study with a single time point is unable to
determine this answer.
Figure 2: I appreciate the combinations of sodium and chloride. I don’t know that A-D are
necessary. E demonstrates the main point. Was there a statistical omnibus test performed
followed by pairwise comparisons with a correction performed? The statistics would be nice to
see in the figure legend.
Figure 5: it would be nice to have the bars be in increasing order of chloride levels. The left bar
would be Cl<99, middle bar would be 99110.
Figure 6 and Figure 5 are a bit repetitive. I personally prefer figure 6.
The figure legends should be bulked up a bit so that each figure is able to stand by itself.
Title: Lower serum chloride concentrations are associated with increased risk of mortality in
critically ill cirrhotic patients: an analysis of the MIMIC-III database
Version: 2 Date: 26 Jan 2021
Reviewer's report:
The authors have done a nice job of editing the original manuscript. They have addressed the
comments appropriately and the manuscript is much improved.
Discussion: first paragraph 4th sentence. I believe there is a typo. It states that the mortality
rate is lower in patients with hypochloremia when the mortality rate was higher in patients with
hypochloremia.
The paragraph discussing the potential relationship of hypochloremia and mortality does not
discuss that chicken or the egg difficulty with this. Hypochloremia may be the result of the
progressive course of cirrhosis and may be an important biomarker of this progression. It
may also exacerbate this course. An observational study with a single time point is unable to
determine this answer.
Figure 2: I appreciate the combinations of sodium and chloride. I don’t know that A-D are
necessary. E demonstrates the main point. Was there a statistical omnibus test performed
followed by pairwise comparisons with a correction performed? The statistics would be nice to
see in the figure legend.
Figure 5: it would be nice to have the bars be in increasing order of chloride levels. The left bar
would be Cl<99, middle bar would be 99110.
Figure 6 and Figure 5 are a bit repetitive. I personally prefer figure 6.
The figure legends should be bulked up a bit so that each figure is able to stand by itself.
Please review this paper.
user
Title: Lower serum chloride concentrations are associated with increased risk of mortality in
critically ill cirrhotic patients: an analysis of the MIMIC-III database
Version: 2 Date: 26 Jan 2021
Reviewer's report:
The authors have done a nice job of editing the original manuscript. They have addressed the
comments appropriately and the manuscript is much improved.
Discussion: first paragraph 4th sentence. I believe there is a typo. It states that the mortality
rate is lower in patients with hypochloremia when the mortality rate was higher in patients with
hypochloremia.
The paragraph discussing the potential relationship of hypochloremia and mortality does not
discuss that chicken or the egg difficulty with this. Hypochloremia may be the result of the
progressive course of cirrhosis and may be an important biomarker of this progression. It
may also exacerbate this course. An observational study with a single time point is unable to
determine this answer.
Figure 2: I appreciate the combinations of sodium and chloride. I don’t know that A-D are
necessary. E demonstrates the main point. Was there a statistical omnibus test performed
followed by pairwise comparisons with a correction performed? The statistics would be nice to
see in the figure legend.
Figure 5: it would be nice to have the bars be in increasing order of chloride levels. The left bar
would be Cl<99, middle bar would be 99110.
Figure 6 and Figure 5 are a bit repetitive. I personally prefer figure 6.
The figure legends should be bulked up a bit so that each figure is able to stand by itself.
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