Title: A novel imaging index for predicting adverse progression in acute-on-chronic liver failure
related to hepatitis B virus: the low erector spine index
Version: 1 Date: 29 Jun 2023
Reviewer's report:
I have reviewed the manuscript “A novel imaging index for predicting adverse progression in
acute-on-chronic liver failure related to Hepatitis B virus: the lower spine index” by Zhou et al.
This is a retrospective study with some interesting findings; however, there are some major and
minor issues that need to be addressed.
Major comments:
• The sarcopenia assessment should be more widely explained, including details about the
software used, the Hounsfield unit threshold for muscle demarcation, and interobserver variation
among the observers. These aspects should be informed and reported in the manuscript.
Minor comments:
Introduction section
• In the first line, consider mentioning the prevalence of sarcopenia in patients with cirrhosis.
• Regarding the second line, the sentence that assumes sarcopenia is lethal should be revised.
Sarcopenia is not lethal by itself.
• Also in the second line, the authors should refer to studies that have found an association
between sarcopenia and ACLF, rather than referring to reviews.
Materials and Methods section
• In the second paragraph, the authors should mention the diagnostic criteria for ACLF according
to APASL.
• In the first paragraph of the subsection on Image acquisition, it would be useful to mention the
median time between CT-scan and hospitalization by ACLF.
Results section
• The outcomes should not be included in the “General characteristics at baseline” table.
Consider using a separate table for this purpose.
• In the first paragraph of subsection 3.4 “ESI and kidney dysfunction,” the sentence in the
second line is incorrect. It should state “43.5% patients with low ESI and 23.2% patients with
high ESI developed kidney dysfunction”.
Discussion section
• In the first paragraph, consider changing the first line, “Sarcopenia is considered a clinical
phenotype of malnutrition in cirrhosis”, as the authors mention below in the discussion
sarcopenia is a more complex scenario where myotoxicity, dysbiosis, and other factors have
been associated.
• In the third paragraph, consider changing the sentence “The reversal of sarcopenia also reduces
the risk of death” to “could reduce the risk of death”, as this has not been thoroughly investigated.
Title: A novel imaging index for predicting adverse progression in acute-on-chronic liver failure
related to hepatitis B virus: the low erector spine index
Version: 1 Date: 29 Jun 2023
Reviewer's report:
I have reviewed the manuscript “A novel imaging index for predicting adverse progression in
acute-on-chronic liver failure related to Hepatitis B virus: the lower spine index” by Zhou et al.
This is a retrospective study with some interesting findings; however, there are some major and
minor issues that need to be addressed.
Major comments:
• The sarcopenia assessment should be more widely explained, including details about the
software used, the Hounsfield unit threshold for muscle demarcation, and interobserver variation
among the observers. These aspects should be informed and reported in the manuscript.
Minor comments:
Introduction section
• In the first line, consider mentioning the prevalence of sarcopenia in patients with cirrhosis.
• Regarding the second line, the sentence that assumes sarcopenia is lethal should be revised.
Sarcopenia is not lethal by itself.
• Also in the second line, the authors should refer to studies that have found an association
between sarcopenia and ACLF, rather than referring to reviews.
Materials and Methods section
• In the second paragraph, the authors should mention the diagnostic criteria for ACLF according
to APASL.
• In the first paragraph of the subsection on Image acquisition, it would be useful to mention the
median time between CT-scan and hospitalization by ACLF.
Results section
• The outcomes should not be included in the “General characteristics at baseline” table.
Consider using a separate table for this purpose.
• In the first paragraph of subsection 3.4 “ESI and kidney dysfunction,” the sentence in the
second line is incorrect. It should state “43.5% patients with low ESI and 23.2% patients with
high ESI developed kidney dysfunction”.
Discussion section
• In the first paragraph, consider changing the first line, “Sarcopenia is considered a clinical
phenotype of malnutrition in cirrhosis”, as the authors mention below in the discussion
sarcopenia is a more complex scenario where myotoxicity, dysbiosis, and other factors have
been associated.
• In the third paragraph, consider changing the sentence “The reversal of sarcopenia also reduces
the risk of death” to “could reduce the risk of death”, as this has not been thoroughly investigated.
Please review this paper.
user
Title: A novel imaging index for predicting adverse progression in acute-on-chronic liver failure
related to hepatitis B virus: the low erector spine index
Version: 1 Date: 29 Jun 2023
Reviewer's report:
I have reviewed the manuscript “A novel imaging index for predicting adverse progression in
acute-on-chronic liver failure related to Hepatitis B virus: the lower spine index” by Zhou et al.
This is a retrospective study with some interesting findings; however, there are some major and
minor issues that need to be addressed.
Major comments:
• The sarcopenia assessment should be more widely explained, including details about the
software used, the Hounsfield unit threshold for muscle demarcation, and interobserver variation
among the observers. These aspects should be informed and reported in the manuscript.
Minor comments:
Introduction section
• In the first line, consider mentioning the prevalence of sarcopenia in patients with cirrhosis.
• Regarding the second line, the sentence that assumes sarcopenia is lethal should be revised.
Sarcopenia is not lethal by itself.
• Also in the second line, the authors should refer to studies that have found an association
between sarcopenia and ACLF, rather than referring to reviews.
Materials and Methods section
• In the second paragraph, the authors should mention the diagnostic criteria for ACLF according
to APASL.
• In the first paragraph of the subsection on Image acquisition, it would be useful to mention the
median time between CT-scan and hospitalization by ACLF.
Results section
• The outcomes should not be included in the “General characteristics at baseline” table.
Consider using a separate table for this purpose.
• In the first paragraph of subsection 3.4 “ESI and kidney dysfunction,” the sentence in the
second line is incorrect. It should state “43.5% patients with low ESI and 23.2% patients with
high ESI developed kidney dysfunction”.
Discussion section
• In the first paragraph, consider changing the first line, “Sarcopenia is considered a clinical
phenotype of malnutrition in cirrhosis”, as the authors mention below in the discussion
sarcopenia is a more complex scenario where myotoxicity, dysbiosis, and other factors have
been associated.
• In the third paragraph, consider changing the sentence “The reversal of sarcopenia also reduces
the risk of death” to “could reduce the risk of death”, as this has not been thoroughly investigated.
assistant