Title: Osteosarcopenia predicts poor survival in patients with cirrhosis: a retrospective study
Version: 1 Date: 08 Apr 2023
Reviewer's report:
“Osteosarcopenia predicts poor survival in patients with cirrhosis” was very interesting in
hepatology. Sarcopenia was paid attention to, but osteoporosis was not fully. In this study, it
is reported that osteosarcopenia has an equal impact on Child BC for survival. From now, the
evaluation of osteosarcopenia is fundamental to the treatment of chronic liver disease.
Since osteosarcopenia is important for liver disease, I have few questions for the authors.
In the background, on page 4, line 3, the authors described “few reported studies have evaluated
this relationship in patients with CLD.” That relation is most importable in this study. If that
relationship has been reported, authors should be referred to previous reports. If only reference
number 21, the authors must write that.
In the method, page 4, line 35, the authors described the definition criteria of osteoporosis.  In
this study, the authors evaluated three bones site, does the diagnosis of osteoporosis need to
meet the criteria in all three? Or is only one site OK? The authors must be clear.
Osteosarcopenia was found to be a more important factor in the prognosis of CLD patients than
sarcopenia or osteoporosis.
In Table 2 and S1, the authors should analyze compared of osteosarcopenia, osteoporosis, and
sarcopenia same as in Figure 2.
In Table 1, patients with osteosarcopenia have low BMI and high age, but age and BMI are not
associated with mortality. However, the relationship between osteoporosis, sex, age, and BMI is
well known. Were Low BMI (18.5>) and high age (65<) not associated with a poor prognosis?
In this study, the authors evaluated the relationship between liver-related mortality and
osteosarcopenia. Since osteosarcopenia is contributed to mortality in other diseases, we could
think that osteosarcopenia is related to all mortality. Is all mortality, including cardiovascular
events and unknown origin, not associated with osteosarcopenia in CLD?
In Table 2, Child BC and osteosarcopenia were independently associated with prognosis. In
Figure 3, Child BC plus osteoporosis group had a more severe prognosis than Child BC or
osteoporosis alone. If so, is osteosarcopenia a poor prognostic factor in Child A?
Authors described that osteosarcopenia is the risk factor for poor prognosis independent of Child
stage and hepatoma. Therefore, the authors should be emphasized the care of sarcopenia and
osteoporosis in cirrhotic patients in the discussion and conclusion.
Title: Osteosarcopenia predicts poor survival in patients with cirrhosis: a retrospective study
Version: 1 Date: 08 Apr 2023
Reviewer's report:
“Osteosarcopenia predicts poor survival in patients with cirrhosis” was very interesting in
hepatology. Sarcopenia was paid attention to, but osteoporosis was not fully. In this study, it
is reported that osteosarcopenia has an equal impact on Child BC for survival. From now, the
evaluation of osteosarcopenia is fundamental to the treatment of chronic liver disease.
Since osteosarcopenia is important for liver disease, I have few questions for the authors.
In the background, on page 4, line 3, the authors described “few reported studies have evaluated
this relationship in patients with CLD.” That relation is most importable in this study. If that
relationship has been reported, authors should be referred to previous reports. If only reference
number 21, the authors must write that.
In the method, page 4, line 35, the authors described the definition criteria of osteoporosis.  In
this study, the authors evaluated three bones site, does the diagnosis of osteoporosis need to
meet the criteria in all three? Or is only one site OK? The authors must be clear.
Osteosarcopenia was found to be a more important factor in the prognosis of CLD patients than
sarcopenia or osteoporosis.
In Table 2 and S1, the authors should analyze compared of osteosarcopenia, osteoporosis, and
sarcopenia same as in Figure 2.
In Table 1, patients with osteosarcopenia have low BMI and high age, but age and BMI are not
associated with mortality. However, the relationship between osteoporosis, sex, age, and BMI is
well known. Were Low BMI (18.5>) and high age (65<) not associated with a poor prognosis?
In this study, the authors evaluated the relationship between liver-related mortality and
osteosarcopenia. Since osteosarcopenia is contributed to mortality in other diseases, we could
think that osteosarcopenia is related to all mortality. Is all mortality, including cardiovascular
events and unknown origin, not associated with osteosarcopenia in CLD?
In Table 2, Child BC and osteosarcopenia were independently associated with prognosis. In
Figure 3, Child BC plus osteoporosis group had a more severe prognosis than Child BC or
osteoporosis alone. If so, is osteosarcopenia a poor prognostic factor in Child A?
Authors described that osteosarcopenia is the risk factor for poor prognosis independent of Child
stage and hepatoma. Therefore, the authors should be emphasized the care of sarcopenia and
osteoporosis in cirrhotic patients in the discussion and conclusion.
Please review this paper.
user
Title: Osteosarcopenia predicts poor survival in patients with cirrhosis: a retrospective study
Version: 1 Date: 08 Apr 2023
Reviewer's report:
“Osteosarcopenia predicts poor survival in patients with cirrhosis” was very interesting in
hepatology. Sarcopenia was paid attention to, but osteoporosis was not fully. In this study, it
is reported that osteosarcopenia has an equal impact on Child BC for survival. From now, the
evaluation of osteosarcopenia is fundamental to the treatment of chronic liver disease.
Since osteosarcopenia is important for liver disease, I have few questions for the authors.
In the background, on page 4, line 3, the authors described “few reported studies have evaluated
this relationship in patients with CLD.” That relation is most importable in this study. If that
relationship has been reported, authors should be referred to previous reports. If only reference
number 21, the authors must write that.
In the method, page 4, line 35, the authors described the definition criteria of osteoporosis.  In
this study, the authors evaluated three bones site, does the diagnosis of osteoporosis need to
meet the criteria in all three? Or is only one site OK? The authors must be clear.
Osteosarcopenia was found to be a more important factor in the prognosis of CLD patients than
sarcopenia or osteoporosis.
In Table 2 and S1, the authors should analyze compared of osteosarcopenia, osteoporosis, and
sarcopenia same as in Figure 2.
In Table 1, patients with osteosarcopenia have low BMI and high age, but age and BMI are not
associated with mortality. However, the relationship between osteoporosis, sex, age, and BMI is
well known. Were Low BMI (18.5>) and high age (65<) not associated with a poor prognosis?
In this study, the authors evaluated the relationship between liver-related mortality and
osteosarcopenia. Since osteosarcopenia is contributed to mortality in other diseases, we could
think that osteosarcopenia is related to all mortality. Is all mortality, including cardiovascular
events and unknown origin, not associated with osteosarcopenia in CLD?
In Table 2, Child BC and osteosarcopenia were independently associated with prognosis. In
Figure 3, Child BC plus osteoporosis group had a more severe prognosis than Child BC or
osteoporosis alone. If so, is osteosarcopenia a poor prognostic factor in Child A?
Authors described that osteosarcopenia is the risk factor for poor prognosis independent of Child
stage and hepatoma. Therefore, the authors should be emphasized the care of sarcopenia and
osteoporosis in cirrhotic patients in the discussion and conclusion.
assistant