Title: Treatment and outcome of hepatorenal syndrome in Japan: A retrospective cohort study
using a national inpatient database
Version: 2 Date: 02 Apr 2023
Reviewer's report:
I am pleased to review the manuscript entitled " Treatment and outcome of hepatorenal syndrome
in Japan: A retrospective cohort study using a national inpatient database" by Okushin K et al.
This is the first nationwide report on real-world management for HRS. Therefore, it is intriguing
and valuable for understanding the situation of HRS in Japan. However, the authors should
answer the comment below.
This study is based on the DPC database in Japan; therefore, the diagnosis of HRS is narrative-
based as a fundamental limitation. In both groups, a small number of patients were classified into
Child-Pugh grade A. The definition of HRS in the Japanese guideline indicates the “cirrhosis and
presence of ascites.” HRS usually develops during the terminal stages of liver disease. HRSs in
Child-Pugh grade A are not readily acceptable. In other reports*,**, there are no cases of Child-
Pugh A. I guess they should be eliminated. What do authors think about it? Please discuss it.
*https://doi.org/10.4254/wjh.v5.i12.685,
**DOI :10.1088/1755-1315/125/1/012214
Title: Treatment and outcome of hepatorenal syndrome in Japan: A retrospective cohort study
using a national inpatient database
Version: 2 Date: 02 Apr 2023
Reviewer's report:
I am pleased to review the manuscript entitled " Treatment and outcome of hepatorenal syndrome
in Japan: A retrospective cohort study using a national inpatient database" by Okushin K et al.
This is the first nationwide report on real-world management for HRS. Therefore, it is intriguing
and valuable for understanding the situation of HRS in Japan. However, the authors should
answer the comment below.
This study is based on the DPC database in Japan; therefore, the diagnosis of HRS is narrative-
based as a fundamental limitation. In both groups, a small number of patients were classified into
Child-Pugh grade A. The definition of HRS in the Japanese guideline indicates the “cirrhosis and
presence of ascites.” HRS usually develops during the terminal stages of liver disease. HRSs in
Child-Pugh grade A are not readily acceptable. In other reports*,**, there are no cases of Child-
Pugh A. I guess they should be eliminated. What do authors think about it? Please discuss it.
*https://doi.org/10.4254/wjh.v5.i12.685,
**DOI :10.1088/1755-1315/125/1/012214
Please review this paper.
user
Title: Treatment and outcome of hepatorenal syndrome in Japan: A retrospective cohort study
using a national inpatient database
Version: 2 Date: 02 Apr 2023
Reviewer's report:
I am pleased to review the manuscript entitled " Treatment and outcome of hepatorenal syndrome
in Japan: A retrospective cohort study using a national inpatient database" by Okushin K et al.
This is the first nationwide report on real-world management for HRS. Therefore, it is intriguing
and valuable for understanding the situation of HRS in Japan. However, the authors should
answer the comment below.
This study is based on the DPC database in Japan; therefore, the diagnosis of HRS is narrative-
based as a fundamental limitation. In both groups, a small number of patients were classified into
Child-Pugh grade A. The definition of HRS in the Japanese guideline indicates the “cirrhosis and
presence of ascites.” HRS usually develops during the terminal stages of liver disease. HRSs in
Child-Pugh grade A are not readily acceptable. In other reports*,**, there are no cases of Child-
Pugh A. I guess they should be eliminated. What do authors think about it? Please discuss it.
*https://doi.org/10.4254/wjh.v5.i12.685,
**DOI :10.1088/1755-1315/125/1/012214
assistant