Title: Effect of L-carnitine Supplementation on Muscle Cramps in Liver Cirrhosis: Results from
a Retrospective Cohort Study
Version: 1 Date: 08 Dec 2024
Reviewer's report:
Line 98: Exclusion criteria were other secondary caused of cramps. By authors own submission
causes of cramps in cirrhosis can be AKI, dehydration, dyselectrolytemia. There is no mention
of these confounding factors in the manuscript.  Authors should have mentioned in the methods
and methodology the prevalence of such predisposing factors in the study population. Ideally
these factors should be corrected before one can comment on the effectiveness of L-carnitine.
A multivariate analysis to take care of confounding factors would have given a more accurate
results on the effectiveness of L-carnitine
Line 11: 27.8% patients in this retrospective study had cramps. The authors could have studied
the factors as to why these patients had cramps while the remaining 71% screened patients did
not have cramps to make this study more insightful. This could have been a secondary objective
of the study
Table 3: Does not explain clearly the correlation of BMI and severity of cramps. It is not clear
from the table if high BMI is protective, or low BMI is protective against cramps
Line 182, 183: There is mention of complete resolution of cramps in certain percentage of
patients. However, there is no table in the manuscript to substantiate this conclusion.
The numbers in each subgroup especially the group with daily cramps is very small hence
making it difficult to come to a conclusion
If these points could be added to the manuscript, then study will have more impact
Title: Effect of L-carnitine Supplementation on Muscle Cramps in Liver Cirrhosis: Results from
a Retrospective Cohort Study
Version: 1 Date: 08 Dec 2024
Reviewer's report:
Line 98: Exclusion criteria were other secondary caused of cramps. By authors own submission
causes of cramps in cirrhosis can be AKI, dehydration, dyselectrolytemia. There is no mention
of these confounding factors in the manuscript.  Authors should have mentioned in the methods
and methodology the prevalence of such predisposing factors in the study population. Ideally
these factors should be corrected before one can comment on the effectiveness of L-carnitine.
A multivariate analysis to take care of confounding factors would have given a more accurate
results on the effectiveness of L-carnitine
Line 11: 27.8% patients in this retrospective study had cramps. The authors could have studied
the factors as to why these patients had cramps while the remaining 71% screened patients did
not have cramps to make this study more insightful. This could have been a secondary objective
of the study
Table 3: Does not explain clearly the correlation of BMI and severity of cramps. It is not clear
from the table if high BMI is protective, or low BMI is protective against cramps
Line 182, 183: There is mention of complete resolution of cramps in certain percentage of
patients. However, there is no table in the manuscript to substantiate this conclusion.
The numbers in each subgroup especially the group with daily cramps is very small hence
making it difficult to come to a conclusion
If these points could be added to the manuscript, then study will have more impact
Please review this paper.
user
Title: Effect of L-carnitine Supplementation on Muscle Cramps in Liver Cirrhosis: Results from
a Retrospective Cohort Study
Version: 1 Date: 08 Dec 2024
Reviewer's report:
Line 98: Exclusion criteria were other secondary caused of cramps. By authors own submission
causes of cramps in cirrhosis can be AKI, dehydration, dyselectrolytemia. There is no mention
of these confounding factors in the manuscript.  Authors should have mentioned in the methods
and methodology the prevalence of such predisposing factors in the study population. Ideally
these factors should be corrected before one can comment on the effectiveness of L-carnitine.
A multivariate analysis to take care of confounding factors would have given a more accurate
results on the effectiveness of L-carnitine
Line 11: 27.8% patients in this retrospective study had cramps. The authors could have studied
the factors as to why these patients had cramps while the remaining 71% screened patients did
not have cramps to make this study more insightful. This could have been a secondary objective
of the study
Table 3: Does not explain clearly the correlation of BMI and severity of cramps. It is not clear
from the table if high BMI is protective, or low BMI is protective against cramps
Line 182, 183: There is mention of complete resolution of cramps in certain percentage of
patients. However, there is no table in the manuscript to substantiate this conclusion.
The numbers in each subgroup especially the group with daily cramps is very small hence
making it difficult to come to a conclusion
If these points could be added to the manuscript, then study will have more impact
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