Reviewer ’s report  
 
Title: Validation of a New Risk Score System for Non -variceal Upper Gastrointestinal Bleeding  
 
Version: 0 Date: 21 Oct 2019  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be in cluded in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
the authors have put a valuable effort in validating new score and have explained its performance  
and comparison in great detail.  
 
However certain areas need to  be elaborated - 
 
Abstract - 
 
1. Mention AUROC's of rest 3 scores  
 
2. Mention whether this new score (INBS) is statistically significantly better than rest 3 scores 
(as CI values are of not much difference).  
 
 
Methods -  
 
1. why age &lt;18 years was only set po int for exclusion. please specify  
 
2. were the scores calculated at admission or at discharge or in follow up  
 
3. were scores calculated manually, or electronically after feeding whole data of clinical, 
biochemical and endoscopic parameters in a particular software  
 
4. regarding primary outcome, how many patients were hospitalized for 30 days.  
 
5. did all deaths occurred in hospital? or some deaths might have occurred after discharge at 
home due to rebleed or comorbity related.  
 
6. did all deaths occured due t o GI bleed? please mention how many were bleed related?  
 
7. please mention whether "hemostatic failure" means failure of endoscopy or interventional 
radiology and/or surgery also included  
 
8. why secondary outcomes were all noted only in high risk group?  
 
9. please specify average endoscopy timing in relation to rebleed while defining rebleed? how 
many cases underwent emergency and urgent endoscopy?  
 
10. how was altered mental status objectively measured, as it is subjective measurement.  
 
11. how was cirrhosis d efined(Compensated and decompensated)?  
 
 
results and discussion - 
 
1. Please mention Negative and positive predictive values of all 4 scores in predicting primary 
and secondary outcomes  
 
2. Were patients  evaluated for 30 days or 3 months?  
 
3. mention AUROC values and confidence intervals of scores with significant difference (if any) 
in describing Length of stay , rebleeding rates, endoscopic hemostasis failure. Can be 
summarized in a tabular form  
 
4. Are scores such as PNED and AIMS65 valida ted for rebleeding or length of stay.  
 
5. in comparing scores for rebleeding, PNED score has in itself a component of rebleeding that 
has 3 points and endoscopic failure that has 4 points. How it is justified to use this score to 
predict rebleed (an event) that has already occurred here.  
 
6.how many cirrhosis patients had coexisting Variceal bleed. please specify. (As they have more 
commonly Variceal bleed). Was any differences in compensated or de -compensated group 
noted?  
 
7. P value is not mentioned in table  5. 
 
8. What were etiologies of patients who expired.  
 
9. please specify mean scores in mortality group and survivor group.  
 
10. please mention if possible mean duration of bleed to hospitalization, and hospitalization to 
endoscopy and bleed to endoscopy.  
 
11. References are too old. latest reference was of 2017. Please add recent ones if any.  
 
Are the meth ods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the c onclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistica l review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing intrests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accep ted for publication , my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons. org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Validation of a New Risk Score System for Non -variceal Upper Gastrointestinal Bleeding  
 
Version: 0 Date: 21 Oct 2019  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be in cluded in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
the authors have put a valuable effort in validating new score and have explained its performance  
and comparison in great detail.  
 
However certain areas need to  be elaborated - 
 
Abstract - 
 
1. Mention AUROC's of rest 3 scores  
 
2. Mention whether this new score (INBS) is statistically significantly better than rest 3 scores 
(as CI values are of not much difference).  
 
 
Methods -  
 
1. why age &lt;18 years was only set po int for exclusion. please specify  
 
2. were the scores calculated at admission or at discharge or in follow up  
 
3. were scores calculated manually, or electronically after feeding whole data of clinical, 
biochemical and endoscopic parameters in a particular software  
 
4. regarding primary outcome, how many patients were hospitalized for 30 days.  
 
5. did all deaths occurred in hospital? or some deaths might have occurred after discharge at 
home due to rebleed or comorbity related.  
 
6. did all deaths occured due t o GI bleed? please mention how many were bleed related?  
 
7. please mention whether "hemostatic failure" means failure of endoscopy or interventional 
radiology and/or surgery also included  
 
8. why secondary outcomes were all noted only in high risk group?  
 
9. please specify average endoscopy timing in relation to rebleed while defining rebleed? how 
many cases underwent emergency and urgent endoscopy?  
 
10. how was altered mental status objectively measured, as it is subjective measurement.  
 
11. how was cirrhosis d efined(Compensated and decompensated)?  
 
 
results and discussion - 
 
1. Please mention Negative and positive predictive values of all 4 scores in predicting primary 
and secondary outcomes  
 
2. Were patients  evaluated for 30 days or 3 months?  
 
3. mention AUROC values and confidence intervals of scores with significant difference (if any) 
in describing Length of stay , rebleeding rates, endoscopic hemostasis failure. Can be 
summarized in a tabular form  
 
4. Are scores such as PNED and AIMS65 valida ted for rebleeding or length of stay.  
 
5. in comparing scores for rebleeding, PNED score has in itself a component of rebleeding that 
has 3 points and endoscopic failure that has 4 points. How it is justified to use this score to 
predict rebleed (an event) that has already occurred here.  
 
6.how many cirrhosis patients had coexisting Variceal bleed. please specify. (As they have more 
commonly Variceal bleed). Was any differences in compensated or de -compensated group 
noted?  
 
7. P value is not mentioned in table  5. 
 
8. What were etiologies of patients who expired.  
 
9. please specify mean scores in mortality group and survivor group.  
 
10. please mention if possible mean duration of bleed to hospitalization, and hospitalization to 
endoscopy and bleed to endoscopy.  
 
11. References are too old. latest reference was of 2017. Please add recent ones if any.  
 
Are the meth ods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the c onclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistica l review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing intrests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accep ted for publication , my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons. org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Validation of a New Risk Score System for Non -variceal Upper Gastrointestinal Bleeding  
 
Version: 0 Date: 21 Oct 2019  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be in cluded in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
the authors have put a valuable effort in validating new score and have explained its performance  
and comparison in great detail.  
 
However certain areas need to  be elaborated - 
 
Abstract - 
 
1. Mention AUROC's of rest 3 scores  
 
2. Mention whether this new score (INBS) is statistically significantly better than rest 3 scores 
(as CI values are of not much difference).  
 
 
Methods -  
 
1. why age &lt;18 years was only set po int for exclusion. please specify  
 
2. were the scores calculated at admission or at discharge or in follow up  
 
3. were scores calculated manually, or electronically after feeding whole data of clinical, 
biochemical and endoscopic parameters in a particular software  
 
4. regarding primary outcome, how many patients were hospitalized for 30 days.  
 
5. did all deaths occurred in hospital? or some deaths might have occurred after discharge at 
home due to rebleed or comorbity related.  
 
6. did all deaths occured due t o GI bleed? please mention how many were bleed related?  
 
7. please mention whether "hemostatic failure" means failure of endoscopy or interventional 
radiology and/or surgery also included  
 
8. why secondary outcomes were all noted only in high risk group?  
 
9. please specify average endoscopy timing in relation to rebleed while defining rebleed? how 
many cases underwent emergency and urgent endoscopy?  
 
10. how was altered mental status objectively measured, as it is subjective measurement.  
 
11. how was cirrhosis d efined(Compensated and decompensated)?  
 
 
results and discussion - 
 
1. Please mention Negative and positive predictive values of all 4 scores in predicting primary 
and secondary outcomes  
 
2. Were patients  evaluated for 30 days or 3 months?  
 
3. mention AUROC values and confidence intervals of scores with significant difference (if any) 
in describing Length of stay , rebleeding rates, endoscopic hemostasis failure. Can be 
summarized in a tabular form  
 
4. Are scores such as PNED and AIMS65 valida ted for rebleeding or length of stay.  
 
5. in comparing scores for rebleeding, PNED score has in itself a component of rebleeding that 
has 3 points and endoscopic failure that has 4 points. How it is justified to use this score to 
predict rebleed (an event) that has already occurred here.  
 
6.how many cirrhosis patients had coexisting Variceal bleed. please specify. (As they have more 
commonly Variceal bleed). Was any differences in compensated or de -compensated group 
noted?  
 
7. P value is not mentioned in table  5. 
 
8. What were etiologies of patients who expired.  
 
9. please specify mean scores in mortality group and survivor group.  
 
10. please mention if possible mean duration of bleed to hospitalization, and hospitalization to 
endoscopy and bleed to endoscopy.  
 
11. References are too old. latest reference was of 2017. Please add recent ones if any.  
 
Are the meth ods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the c onclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistica l review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing intrests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accep ted for publication , my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons. org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant