Title: Diagnostic Performance of Procalcitonin for Bacterial Infection in Severe Alcoholic
Hepatitis Compared with C-Reactive Protein
Version: 1 Date: 16 Aug 2024
Reviewer's report:
The study is of interest. The authors have attempted to determine the prognostic value of
procalcitonin (PCT) and C reactive (CRP) for detecting bacterial infections in patients with
severe alcoholic hepatitis (AHH). The results of the study showed that procalcitonin seems to
perform better than CRP in the early detection of bacterial infections. The results may be useful
in clinical practice. However, the study has some drawbacks that should be addressed:
MAJOR COMMENTS:
1. One of the main problems with the study is the diagnostic criteria used for diagnosis of
severe acute alcoholic hepatitis (AHH). Patients with AHH often present systemic inflammatory
responses, which includes elevated markers of inflammation. While the diagnosis of AHH
was made based on NIAAA criteria, it was not confirmed by liver histology, making the
diagnosis possible rather than definitive. Therefore, this limitation should be acknowledged in
the discussion of the study.
2. Another significant concert is that 40% of infections were culture-negative. It raises the
possibility that the inflammatory markers observed might be attributable to AHH itself rather
than an actual bacterial infection. It may be interesting to perform a subanalysis of culture
positive bacterial infections. And it should be highlighted in the discussion.
MINOR
3. Table 1 should include the number of patients treated with corticoids.
4. According to the text, the number of patients with infections were 31, but the number of types
of infections were 30. The authors should clarify which infection is unaccounted for.
5. Authors should clarify that causes of sepsis discussed in the previous paragraph are also
included in patients with sepsis.
6. It would be valuable to compare the characteristics of patients with bacterial infections
who developed sepsis and AHH versus those with bacterial infections without sepsis. This
comparison could enhance the understanding of clinical characteristics of groups illustrated in
Figure 3.
7. Fig 4. Evaluated patients with sepsis and SIRS. In methods, sepsis is defined as bacterial
infection and SIRS. Figures 3 and 4 appear to overlap, the authors should clarify this.
8. It may be interesting to correlate CRP and PCT with organ failure and ACLF and mortality,
if authors had the data.
9. In the discussion authors mention that only one study has evaluated PCT in AHH. However,
authors should include in the discussion the study by Altamirano et al., (PMID: 25761863),
which may provide further support for the results.
Title: Diagnostic Performance of Procalcitonin for Bacterial Infection in Severe Alcoholic
Hepatitis Compared with C-Reactive Protein
Version: 1 Date: 16 Aug 2024
Reviewer's report:
The study is of interest. The authors have attempted to determine the prognostic value of
procalcitonin (PCT) and C reactive (CRP) for detecting bacterial infections in patients with
severe alcoholic hepatitis (AHH). The results of the study showed that procalcitonin seems to
perform better than CRP in the early detection of bacterial infections. The results may be useful
in clinical practice. However, the study has some drawbacks that should be addressed:
MAJOR COMMENTS:
1. One of the main problems with the study is the diagnostic criteria used for diagnosis of
severe acute alcoholic hepatitis (AHH). Patients with AHH often present systemic inflammatory
responses, which includes elevated markers of inflammation. While the diagnosis of AHH
was made based on NIAAA criteria, it was not confirmed by liver histology, making the
diagnosis possible rather than definitive. Therefore, this limitation should be acknowledged in
the discussion of the study.
2. Another significant concert is that 40% of infections were culture-negative. It raises the
possibility that the inflammatory markers observed might be attributable to AHH itself rather
than an actual bacterial infection. It may be interesting to perform a subanalysis of culture
positive bacterial infections. And it should be highlighted in the discussion.
MINOR
3. Table 1 should include the number of patients treated with corticoids.
4. According to the text, the number of patients with infections were 31, but the number of types
of infections were 30. The authors should clarify which infection is unaccounted for.
5. Authors should clarify that causes of sepsis discussed in the previous paragraph are also
included in patients with sepsis.
6. It would be valuable to compare the characteristics of patients with bacterial infections
who developed sepsis and AHH versus those with bacterial infections without sepsis. This
comparison could enhance the understanding of clinical characteristics of groups illustrated in
Figure 3.
7. Fig 4. Evaluated patients with sepsis and SIRS. In methods, sepsis is defined as bacterial
infection and SIRS. Figures 3 and 4 appear to overlap, the authors should clarify this.
8. It may be interesting to correlate CRP and PCT with organ failure and ACLF and mortality,
if authors had the data.
9. In the discussion authors mention that only one study has evaluated PCT in AHH. However,
authors should include in the discussion the study by Altamirano et al., (PMID: 25761863),
which may provide further support for the results.
Please review this paper.
user
Title: Diagnostic Performance of Procalcitonin for Bacterial Infection in Severe Alcoholic
Hepatitis Compared with C-Reactive Protein
Version: 1 Date: 16 Aug 2024
Reviewer's report:
The study is of interest. The authors have attempted to determine the prognostic value of
procalcitonin (PCT) and C reactive (CRP) for detecting bacterial infections in patients with
severe alcoholic hepatitis (AHH). The results of the study showed that procalcitonin seems to
perform better than CRP in the early detection of bacterial infections. The results may be useful
in clinical practice. However, the study has some drawbacks that should be addressed:
MAJOR COMMENTS:
1. One of the main problems with the study is the diagnostic criteria used for diagnosis of
severe acute alcoholic hepatitis (AHH). Patients with AHH often present systemic inflammatory
responses, which includes elevated markers of inflammation. While the diagnosis of AHH
was made based on NIAAA criteria, it was not confirmed by liver histology, making the
diagnosis possible rather than definitive. Therefore, this limitation should be acknowledged in
the discussion of the study.
2. Another significant concert is that 40% of infections were culture-negative. It raises the
possibility that the inflammatory markers observed might be attributable to AHH itself rather
than an actual bacterial infection. It may be interesting to perform a subanalysis of culture
positive bacterial infections. And it should be highlighted in the discussion.
MINOR
3. Table 1 should include the number of patients treated with corticoids.
4. According to the text, the number of patients with infections were 31, but the number of types
of infections were 30. The authors should clarify which infection is unaccounted for.
5. Authors should clarify that causes of sepsis discussed in the previous paragraph are also
included in patients with sepsis.
6. It would be valuable to compare the characteristics of patients with bacterial infections
who developed sepsis and AHH versus those with bacterial infections without sepsis. This
comparison could enhance the understanding of clinical characteristics of groups illustrated in
Figure 3.
7. Fig 4. Evaluated patients with sepsis and SIRS. In methods, sepsis is defined as bacterial
infection and SIRS. Figures 3 and 4 appear to overlap, the authors should clarify this.
8. It may be interesting to correlate CRP and PCT with organ failure and ACLF and mortality,
if authors had the data.
9. In the discussion authors mention that only one study has evaluated PCT in AHH. However,
authors should include in the discussion the study by Altamirano et al., (PMID: 25761863),
which may provide further support for the results.
assistant