Title: FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic
fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran
Version: 1 Date: 13 Oct 2021
Reviewer's report:
Review from Dr. Mary K. Y. Afihene
The study tried to explore alternative methods in assessing liver fibrosis. Although the study is
important, there are some major issues that needs to be addressed.
Tittle:
1. The tittle of the study did not state where the study was conducted. Study setting should be
included.
2. The study sought to assess hepatic fibrosis and not diagnosis. The authors should revise
appropriately
Abstract
1. line 7 of the abstract background; Please write the tests in the order in which they appear in
the tittle
2. “Aim to” has been repeated in line 7, please delete one
3. Please change the word diagnosis to assessment in lines 2, 9 and 27.
Background
1. it is better to describe NAFLD as a spectrum; NAFLD – steatohepatitis – fibrosis - cirrhosis.
2. The authors gave a global prevalence without recall to the local picture. They should improve
the logical flow of the background (i.e., situation, problem, objective and response).
3. Line 60 – 65; The statement is too long with multiple ideas; I suggest you split them into two
and site each appropriately. Refine the construction of the sentence; remove while and replace
the statement “in close relationship” with “closely related”
4. Line 71; The sentence “Abdominal ultrasonography (US) is the most common imaging
method for the diagnosis of NAFLD with sensitivity and specificity of around 85% and
90%, respectively; however, it has some limitations, including being operator-dependent and
ineffective in patients with central obesity” should precede line 66. Also, I suggest you reference
the second statement concerning the limitations separately.
5. The last paraph of the background failed to describe the burden of the disease in Iran,
availability and cost of fibroscan which should be highlighted in the justification of the study.
Methodology
1. The information on sample size estimation is not sufficient, the authors should provide details
of how they arrived at the sample size of 205 and elaborate data collection tools
2. The study gathered data from human participants. However, there is no statement in the
manuscript on ethical approval from any regulatory authority and inform consent from the
participants.
Results
1. The results is too scanty, Please provide a descriptive analysis of the background
characteristics and laboratory indices
2. Although there is a positive relationship the correlation is a weak one. The authors should
describe the nature of correlation that was found.
3. Mann-Whitney test used is inappropriate. This test is suitable for comparing the difference
in median not means.
Discussion
1. Paragraph one of the discussions should be moved to the background.
2. The first paragraph of the discussion should highlight the major finding of the study. This was
not done in this study. The authors should revise the discussion and relate to current literature.
Title: FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic
fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran
Version: 1 Date: 13 Oct 2021
Reviewer's report:
Review from Dr. Mary K. Y. Afihene
The study tried to explore alternative methods in assessing liver fibrosis. Although the study is
important, there are some major issues that needs to be addressed.
Tittle:
1. The tittle of the study did not state where the study was conducted. Study setting should be
included.
2. The study sought to assess hepatic fibrosis and not diagnosis. The authors should revise
appropriately
Abstract
1. line 7 of the abstract background; Please write the tests in the order in which they appear in
the tittle
2. “Aim to” has been repeated in line 7, please delete one
3. Please change the word diagnosis to assessment in lines 2, 9 and 27.
Background
1. it is better to describe NAFLD as a spectrum; NAFLD – steatohepatitis – fibrosis - cirrhosis.
2. The authors gave a global prevalence without recall to the local picture. They should improve
the logical flow of the background (i.e., situation, problem, objective and response).
3. Line 60 – 65; The statement is too long with multiple ideas; I suggest you split them into two
and site each appropriately. Refine the construction of the sentence; remove while and replace
the statement “in close relationship” with “closely related”
4. Line 71; The sentence “Abdominal ultrasonography (US) is the most common imaging
method for the diagnosis of NAFLD with sensitivity and specificity of around 85% and
90%, respectively; however, it has some limitations, including being operator-dependent and
ineffective in patients with central obesity” should precede line 66. Also, I suggest you reference
the second statement concerning the limitations separately.
5. The last paraph of the background failed to describe the burden of the disease in Iran,
availability and cost of fibroscan which should be highlighted in the justification of the study.
Methodology
1. The information on sample size estimation is not sufficient, the authors should provide details
of how they arrived at the sample size of 205 and elaborate data collection tools
2. The study gathered data from human participants. However, there is no statement in the
manuscript on ethical approval from any regulatory authority and inform consent from the
participants.
Results
1. The results is too scanty, Please provide a descriptive analysis of the background
characteristics and laboratory indices
2. Although there is a positive relationship the correlation is a weak one. The authors should
describe the nature of correlation that was found.
3. Mann-Whitney test used is inappropriate. This test is suitable for comparing the difference
in median not means.
Discussion
1. Paragraph one of the discussions should be moved to the background.
2. The first paragraph of the discussion should highlight the major finding of the study. This was
not done in this study. The authors should revise the discussion and relate to current literature.
Please review this paper.
user
Title: FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic
fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran
Version: 1 Date: 13 Oct 2021
Reviewer's report:
Review from Dr. Mary K. Y. Afihene
The study tried to explore alternative methods in assessing liver fibrosis. Although the study is
important, there are some major issues that needs to be addressed.
Tittle:
1. The tittle of the study did not state where the study was conducted. Study setting should be
included.
2. The study sought to assess hepatic fibrosis and not diagnosis. The authors should revise
appropriately
Abstract
1. line 7 of the abstract background; Please write the tests in the order in which they appear in
the tittle
2. “Aim to” has been repeated in line 7, please delete one
3. Please change the word diagnosis to assessment in lines 2, 9 and 27.
Background
1. it is better to describe NAFLD as a spectrum; NAFLD – steatohepatitis – fibrosis - cirrhosis.
2. The authors gave a global prevalence without recall to the local picture. They should improve
the logical flow of the background (i.e., situation, problem, objective and response).
3. Line 60 – 65; The statement is too long with multiple ideas; I suggest you split them into two
and site each appropriately. Refine the construction of the sentence; remove while and replace
the statement “in close relationship” with “closely related”
4. Line 71; The sentence “Abdominal ultrasonography (US) is the most common imaging
method for the diagnosis of NAFLD with sensitivity and specificity of around 85% and
90%, respectively; however, it has some limitations, including being operator-dependent and
ineffective in patients with central obesity” should precede line 66. Also, I suggest you reference
the second statement concerning the limitations separately.
5. The last paraph of the background failed to describe the burden of the disease in Iran,
availability and cost of fibroscan which should be highlighted in the justification of the study.
Methodology
1. The information on sample size estimation is not sufficient, the authors should provide details
of how they arrived at the sample size of 205 and elaborate data collection tools
2. The study gathered data from human participants. However, there is no statement in the
manuscript on ethical approval from any regulatory authority and inform consent from the
participants.
Results
1. The results is too scanty, Please provide a descriptive analysis of the background
characteristics and laboratory indices
2. Although there is a positive relationship the correlation is a weak one. The authors should
describe the nature of correlation that was found.
3. Mann-Whitney test used is inappropriate. This test is suitable for comparing the difference
in median not means.
Discussion
1. Paragraph one of the discussions should be moved to the background.
2. The first paragraph of the discussion should highlight the major finding of the study. This was
not done in this study. The authors should revise the discussion and relate to current literature.
assistant