Title: Development and validation of a nomogram based on Lasso-Logistic regression for
predicting splenomegaly secondary to acute pancreatitis
Version: 1 Date: 28 May 2024
Reviewer's report:
Thank you for the opportunity to review the manuscript titled “Development and validation
of a nomogram based on Lasso-Logistic regression for predicting splenomegaly secondary to
acute pancreatitis.” Many complications related to acute pancreatitis continue to be explored,
and splanchnic vein thrombosis is one of the vascular complications under investigation. Below
are my comments on this study:
-Firstly, why was the relationship between acute pancreatitis and splenomegaly investigated
in this study? In the introduction section, it states: "Clinically, there is an urgent need for a
weighted risk score to assist physicians in distinguishing between high-risk and low-risk patients
for SSAP." As a clinician who has managed hundreds of patients with acute pancreatitis, I can
say that this statement seems to be an exaggeration. Furthermore, I have not come across any
recommendations suggesting the need to explore the relationship between splenomegaly and the
prognosis of acute pancreatitis. The revised Atlanta classification of acute pancreatitis includes
definitions of vascular complications, among which splanchnic vein thrombosis (splenic, portal,
and/or superior mesenteric veins) is one. It is the fact that there is significant discussion on how
to manage this condition (e.g., the indication for anticoagulation). Venous thrombosis can lead to
splenomegaly, which is a fact, however, does isolated splenomegaly require specific treatment?
If not, which is likely the case, Why should splenomegaly in acute pancreatitis be investigated
in isolation and a nomogram developed to predict it?
-Splenomegaly can have many causes, and you have also followed patients post-discharge.
Moreover, a low cut-off value for splenomegaly (9.76 cm) was used, which might have classified
many patients who should be considered within the normal range into the splenomegaly group.
Besides that, The study on which this cut-off value is based was conducted approximately 20
years ago (2005).
-Spleen size is significantly influenced by variables such as gender, age, height, and weight.
Additionally, it can vary by 10-20% based on the individual's hydration status throughout the
day. Considering all these factors, defining splenomegaly with a single cut-off value can lead
to serious classification errors.
-For case-control matching, why was random assignment used instead of propensity score
matching with appropriate covariates, such as gender, height, and weight? Random selection
without adjusting for these confounding factors introduces a significant risk of selection bias.
Title: Development and validation of a nomogram based on Lasso-Logistic regression for
predicting splenomegaly secondary to acute pancreatitis
Version: 1 Date: 28 May 2024
Reviewer's report:
Thank you for the opportunity to review the manuscript titled “Development and validation
of a nomogram based on Lasso-Logistic regression for predicting splenomegaly secondary to
acute pancreatitis.” Many complications related to acute pancreatitis continue to be explored,
and splanchnic vein thrombosis is one of the vascular complications under investigation. Below
are my comments on this study:
-Firstly, why was the relationship between acute pancreatitis and splenomegaly investigated
in this study? In the introduction section, it states: "Clinically, there is an urgent need for a
weighted risk score to assist physicians in distinguishing between high-risk and low-risk patients
for SSAP." As a clinician who has managed hundreds of patients with acute pancreatitis, I can
say that this statement seems to be an exaggeration. Furthermore, I have not come across any
recommendations suggesting the need to explore the relationship between splenomegaly and the
prognosis of acute pancreatitis. The revised Atlanta classification of acute pancreatitis includes
definitions of vascular complications, among which splanchnic vein thrombosis (splenic, portal,
and/or superior mesenteric veins) is one. It is the fact that there is significant discussion on how
to manage this condition (e.g., the indication for anticoagulation). Venous thrombosis can lead to
splenomegaly, which is a fact, however, does isolated splenomegaly require specific treatment?
If not, which is likely the case, Why should splenomegaly in acute pancreatitis be investigated
in isolation and a nomogram developed to predict it?
-Splenomegaly can have many causes, and you have also followed patients post-discharge.
Moreover, a low cut-off value for splenomegaly (9.76 cm) was used, which might have classified
many patients who should be considered within the normal range into the splenomegaly group.
Besides that, The study on which this cut-off value is based was conducted approximately 20
years ago (2005).
-Spleen size is significantly influenced by variables such as gender, age, height, and weight.
Additionally, it can vary by 10-20% based on the individual's hydration status throughout the
day. Considering all these factors, defining splenomegaly with a single cut-off value can lead
to serious classification errors.
-For case-control matching, why was random assignment used instead of propensity score
matching with appropriate covariates, such as gender, height, and weight? Random selection
without adjusting for these confounding factors introduces a significant risk of selection bias.
Please review this paper.
user
Title: Development and validation of a nomogram based on Lasso-Logistic regression for
predicting splenomegaly secondary to acute pancreatitis
Version: 1 Date: 28 May 2024
Reviewer's report:
Thank you for the opportunity to review the manuscript titled “Development and validation
of a nomogram based on Lasso-Logistic regression for predicting splenomegaly secondary to
acute pancreatitis.” Many complications related to acute pancreatitis continue to be explored,
and splanchnic vein thrombosis is one of the vascular complications under investigation. Below
are my comments on this study:
-Firstly, why was the relationship between acute pancreatitis and splenomegaly investigated
in this study? In the introduction section, it states: "Clinically, there is an urgent need for a
weighted risk score to assist physicians in distinguishing between high-risk and low-risk patients
for SSAP." As a clinician who has managed hundreds of patients with acute pancreatitis, I can
say that this statement seems to be an exaggeration. Furthermore, I have not come across any
recommendations suggesting the need to explore the relationship between splenomegaly and the
prognosis of acute pancreatitis. The revised Atlanta classification of acute pancreatitis includes
definitions of vascular complications, among which splanchnic vein thrombosis (splenic, portal,
and/or superior mesenteric veins) is one. It is the fact that there is significant discussion on how
to manage this condition (e.g., the indication for anticoagulation). Venous thrombosis can lead to
splenomegaly, which is a fact, however, does isolated splenomegaly require specific treatment?
If not, which is likely the case, Why should splenomegaly in acute pancreatitis be investigated
in isolation and a nomogram developed to predict it?
-Splenomegaly can have many causes, and you have also followed patients post-discharge.
Moreover, a low cut-off value for splenomegaly (9.76 cm) was used, which might have classified
many patients who should be considered within the normal range into the splenomegaly group.
Besides that, The study on which this cut-off value is based was conducted approximately 20
years ago (2005).
-Spleen size is significantly influenced by variables such as gender, age, height, and weight.
Additionally, it can vary by 10-20% based on the individual's hydration status throughout the
day. Considering all these factors, defining splenomegaly with a single cut-off value can lead
to serious classification errors.
-For case-control matching, why was random assignment used instead of propensity score
matching with appropriate covariates, such as gender, height, and weight? Random selection
without adjusting for these confounding factors introduces a significant risk of selection bias.
assistant