Title: Serum Superoxide Dismutase Level Is a Potential Biomarker of Disease Prognosis in
Patients with HEV-induced Liver Failure
Version: 0 Date: 03 Jul 2021
Reviewer's report:
Although the authors studied various subsets of patients with HEV infection the presenting
clinical phenotypes are a major confounder. ALF patients are grouped together with ACLF
presentations under a label of "liver failure" and compared to healthy controls and patients with
HEV hepatitis only. The different serum levels may not be at all HEV disease/presentation
specific, but merely features of cholestatic liver disease of all etiologies. It would have been
advisable to have a non HEV control group of "liver failure" patients.
Looking at the Kaplan Meier curve and individual SOD levels measuring >400 it looks as though
that only a small number in the ALF group had a level above 400. The number of patients above
the cutoff level should have been provided.
Liver failure is not always an inflammation mediated hepatocellular injury process as stated in
"Background".
The definition of "liver failure" 2nd paragraph Background section is inadequate.
At what time points were the measurements taken and were these timings identical in relation
to disease progress and presentation between groups? Where any patients in the ACLF or ALF
groups transplanted, if so how was the data for transplanted patients analyzed/censored?
What was the rationale to measure serum rather than tissue levels from biopsy data? This should
be explained.
There are a number of language and expression errors - too many to individually list them all.
Appropriate language revision and editing is required. In the abstract and under Methods the
authors state that SOD levels were estimated - surely and given the elaborate lab tests performed
they must have been measured!
In Results 1st sentence "HEV induced liver failure patients showed increased SOD levels
compared with...
Background first paragraph it is countries rather than counties, the whole sentence would need
revising. Likewise the 2nd paragraph in this section would require rephrasing.
It should read HEV ACLF on the background of rather than patients based on ALD or CHB.
Title: Serum Superoxide Dismutase Level Is a Potential Biomarker of Disease Prognosis in
Patients with HEV-induced Liver Failure
Version: 0 Date: 03 Jul 2021
Reviewer's report:
Although the authors studied various subsets of patients with HEV infection the presenting
clinical phenotypes are a major confounder. ALF patients are grouped together with ACLF
presentations under a label of "liver failure" and compared to healthy controls and patients with
HEV hepatitis only. The different serum levels may not be at all HEV disease/presentation
specific, but merely features of cholestatic liver disease of all etiologies. It would have been
advisable to have a non HEV control group of "liver failure" patients.
Looking at the Kaplan Meier curve and individual SOD levels measuring >400 it looks as though
that only a small number in the ALF group had a level above 400. The number of patients above
the cutoff level should have been provided.
Liver failure is not always an inflammation mediated hepatocellular injury process as stated in
"Background".
The definition of "liver failure" 2nd paragraph Background section is inadequate.
At what time points were the measurements taken and were these timings identical in relation
to disease progress and presentation between groups? Where any patients in the ACLF or ALF
groups transplanted, if so how was the data for transplanted patients analyzed/censored?
What was the rationale to measure serum rather than tissue levels from biopsy data? This should
be explained.
There are a number of language and expression errors - too many to individually list them all.
Appropriate language revision and editing is required. In the abstract and under Methods the
authors state that SOD levels were estimated - surely and given the elaborate lab tests performed
they must have been measured!
In Results 1st sentence "HEV induced liver failure patients showed increased SOD levels
compared with...
Background first paragraph it is countries rather than counties, the whole sentence would need
revising. Likewise the 2nd paragraph in this section would require rephrasing.
It should read HEV ACLF on the background of rather than patients based on ALD or CHB.
Please review this paper.
user
Title: Serum Superoxide Dismutase Level Is a Potential Biomarker of Disease Prognosis in
Patients with HEV-induced Liver Failure
Version: 0 Date: 03 Jul 2021
Reviewer's report:
Although the authors studied various subsets of patients with HEV infection the presenting
clinical phenotypes are a major confounder. ALF patients are grouped together with ACLF
presentations under a label of "liver failure" and compared to healthy controls and patients with
HEV hepatitis only. The different serum levels may not be at all HEV disease/presentation
specific, but merely features of cholestatic liver disease of all etiologies. It would have been
advisable to have a non HEV control group of "liver failure" patients.
Looking at the Kaplan Meier curve and individual SOD levels measuring >400 it looks as though
that only a small number in the ALF group had a level above 400. The number of patients above
the cutoff level should have been provided.
Liver failure is not always an inflammation mediated hepatocellular injury process as stated in
"Background".
The definition of "liver failure" 2nd paragraph Background section is inadequate.
At what time points were the measurements taken and were these timings identical in relation
to disease progress and presentation between groups? Where any patients in the ACLF or ALF
groups transplanted, if so how was the data for transplanted patients analyzed/censored?
What was the rationale to measure serum rather than tissue levels from biopsy data? This should
be explained.
There are a number of language and expression errors - too many to individually list them all.
Appropriate language revision and editing is required. In the abstract and under Methods the
authors state that SOD levels were estimated - surely and given the elaborate lab tests performed
they must have been measured!
In Results 1st sentence "HEV induced liver failure patients showed increased SOD levels
compared with...
Background first paragraph it is countries rather than counties, the whole sentence would need
revising. Likewise the 2nd paragraph in this section would require rephrasing.
It should read HEV ACLF on the background of rather than patients based on ALD or CHB.
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