Reviewer ’s report  
 
Title:  Evaluation of scoring systems without endoscopic findings for predicting outcomes in 
patients with upper gastrointestinal bleeding  
 
Version: 0 Date: 27 Aug 2017 
 
Reviewer:  Wei-Lun Chang  
 
Reviewer’s report:  
 
This retrospective study compared the applicability of Glasgow -Blatchford score (GBS), 
modified GBS (mGBS), and pre -endoscopy Rockall score (Pre -E RS) in predicting the need for 
endoscopic intervention and 30 -day mortality. The results are quite similar to  previous studies 
showing that GBS is better at deciding endoscopic intervention. And RS is better for predicting 
30-day mortality.  
 
Abstract  
 
1. "Based on AUC analyses of sensitivities and specificities, the optimal cutoff mGBS and 
GBS for the need for interventions was (70.71 % sensitivity, 89.35% specificity) and 9 (73.57 % 
sensitivity, 82.90% specificity) respectively, and optimal cutoff Pre -E RS for 30 -day mortality 
was 4 (88.0 % sensitivity, 97.52% specificity)." There seemed to be a word missing in this 
sentence. What is the optimal cutoff for mGBS?   
 
Method  
 
1. In page 7 line 3: Octreotide and glypressin are two different drugs, please cor rect. 
 
Result  
 
1. Table 3 is suggested to include information of hemostatic intervention, so that the 
paragraph of "Endoscopic findings" can be shortened.  
 
2. A table or figure showing the patient numbers in each score and the patient numbers 
that need inte rvention of the 3 scoring systems will help readers understand the 
disease severity and the ratio of intervention in each score.  
 
3. Besides the above scoring system, "AIMS65" had been shown to be superior in 
predicting 30 -day mortality and rebleeding (Gas trointest Endosc 2016;83:1151 -60; J 
Dig Dis 2016;17:820 -828). How about AIM65 in predicting 30 -day mortality 
compare to pre -RS or full RS in their study population?  
 
4. Previous study showed these scoring system were less accurate in predicting outcome 
of patients with variceal bleeding (J Gastroenterol Hepatol 2016;31:761 -7). However, 
the author included patients with variceal bleeding. Will the result be different if the 
analyses were stratified by non -variceal vs. variceal bleeding?  
 
5. The selection of op timal cut -off is usually based on youden index, did the author 
select their optimal value based on it?  
 
Discussion  
 
1. The statement "However, RS is not suitable for an early decision on need of urgent 
interventions or predicting 30 -day mortality in the man agement of patients with 
UGIB, since it requires endoscopic finding" is not true since their data showed Pre -E 
RS is good at predicting 30 -day mortality. Moreover, they do not show the data of RS 
to predict 30 -day mortality. The statement should be modifie d. 
 
2. The author stated "Our results suggest that patients with GBS > 9 or mGBS > 9 need 
hemostatic interventions and have to undergo early gastroscopy". The author should 
provide data to show that in patients with GBS or mGBS > 9, a shorter presentation -
to-endoscopy time is related to a lower mortality.  
 
Reference:  
 
1. Some redundant words are seen in reference 5: Barkun AN, Bardou M, Kuipers EJ, 
Sung J, Hunt RH, Martel M, Sinclair P; International Consensus Upper 
Gastrointestinal Bleeding Conference Group . International Consensus Upper 
Gastrointestinal Bleeding Conference G. International consensus recommendations 
on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann 
Intern Med. 2010;152:101 -13. 
 
Are the methods 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 conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript  or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in a n organisation that 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 relat ion 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 interests  
 
I agree to the open peer review  policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted 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 wis h to be included in my named report can be included 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:  Evaluation of scoring systems without endoscopic findings for predicting outcomes in 
patients with upper gastrointestinal bleeding  
 
Version: 0 Date: 27 Aug 2017 
 
Reviewer:  Wei-Lun Chang  
 
Reviewer’s report:  
 
This retrospective study compared the applicability of Glasgow -Blatchford score (GBS), 
modified GBS (mGBS), and pre -endoscopy Rockall score (Pre -E RS) in predicting the need for 
endoscopic intervention and 30 -day mortality. The results are quite similar to  previous studies 
showing that GBS is better at deciding endoscopic intervention. And RS is better for predicting 
30-day mortality.  
 
Abstract  
 
1. "Based on AUC analyses of sensitivities and specificities, the optimal cutoff mGBS and 
GBS for the need for interventions was (70.71 % sensitivity, 89.35% specificity) and 9 (73.57 % 
sensitivity, 82.90% specificity) respectively, and optimal cutoff Pre -E RS for 30 -day mortality 
was 4 (88.0 % sensitivity, 97.52% specificity)." There seemed to be a word missing in this 
sentence. What is the optimal cutoff for mGBS?   
 
Method  
 
1. In page 7 line 3: Octreotide and glypressin are two different drugs, please cor rect. 
 
Result  
 
1. Table 3 is suggested to include information of hemostatic intervention, so that the 
paragraph of "Endoscopic findings" can be shortened.  
 
2. A table or figure showing the patient numbers in each score and the patient numbers 
that need inte rvention of the 3 scoring systems will help readers understand the 
disease severity and the ratio of intervention in each score.  
 
3. Besides the above scoring system, "AIMS65" had been shown to be superior in 
predicting 30 -day mortality and rebleeding (Gas trointest Endosc 2016;83:1151 -60; J 
Dig Dis 2016;17:820 -828). How about AIM65 in predicting 30 -day mortality 
compare to pre -RS or full RS in their study population?  
 
4. Previous study showed these scoring system were less accurate in predicting outcome 
of patients with variceal bleeding (J Gastroenterol Hepatol 2016;31:761 -7). However, 
the author included patients with variceal bleeding. Will the result be different if the 
analyses were stratified by non -variceal vs. variceal bleeding?  
 
5. The selection of op timal cut -off is usually based on youden index, did the author 
select their optimal value based on it?  
 
Discussion  
 
1. The statement "However, RS is not suitable for an early decision on need of urgent 
interventions or predicting 30 -day mortality in the man agement of patients with 
UGIB, since it requires endoscopic finding" is not true since their data showed Pre -E 
RS is good at predicting 30 -day mortality. Moreover, they do not show the data of RS 
to predict 30 -day mortality. The statement should be modifie d. 
 
2. The author stated "Our results suggest that patients with GBS > 9 or mGBS > 9 need 
hemostatic interventions and have to undergo early gastroscopy". The author should 
provide data to show that in patients with GBS or mGBS > 9, a shorter presentation -
to-endoscopy time is related to a lower mortality.  
 
Reference:  
 
1. Some redundant words are seen in reference 5: Barkun AN, Bardou M, Kuipers EJ, 
Sung J, Hunt RH, Martel M, Sinclair P; International Consensus Upper 
Gastrointestinal Bleeding Conference Group . International Consensus Upper 
Gastrointestinal Bleeding Conference G. International consensus recommendations 
on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann 
Intern Med. 2010;152:101 -13. 
 
Are the methods 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 conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript  or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in a n organisation that 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 relat ion 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 interests  
 
I agree to the open peer review  policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted 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 wis h to be included in my named report can be included 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:  Evaluation of scoring systems without endoscopic findings for predicting outcomes in 
patients with upper gastrointestinal bleeding  
 
Version: 0 Date: 27 Aug 2017 
 
Reviewer:  Wei-Lun Chang  
 
Reviewer’s report:  
 
This retrospective study compared the applicability of Glasgow -Blatchford score (GBS), 
modified GBS (mGBS), and pre -endoscopy Rockall score (Pre -E RS) in predicting the need for 
endoscopic intervention and 30 -day mortality. The results are quite similar to  previous studies 
showing that GBS is better at deciding endoscopic intervention. And RS is better for predicting 
30-day mortality.  
 
Abstract  
 
1. "Based on AUC analyses of sensitivities and specificities, the optimal cutoff mGBS and 
GBS for the need for interventions was (70.71 % sensitivity, 89.35% specificity) and 9 (73.57 % 
sensitivity, 82.90% specificity) respectively, and optimal cutoff Pre -E RS for 30 -day mortality 
was 4 (88.0 % sensitivity, 97.52% specificity)." There seemed to be a word missing in this 
sentence. What is the optimal cutoff for mGBS?   
 
Method  
 
1. In page 7 line 3: Octreotide and glypressin are two different drugs, please cor rect. 
 
Result  
 
1. Table 3 is suggested to include information of hemostatic intervention, so that the 
paragraph of "Endoscopic findings" can be shortened.  
 
2. A table or figure showing the patient numbers in each score and the patient numbers 
that need inte rvention of the 3 scoring systems will help readers understand the 
disease severity and the ratio of intervention in each score.  
 
3. Besides the above scoring system, "AIMS65" had been shown to be superior in 
predicting 30 -day mortality and rebleeding (Gas trointest Endosc 2016;83:1151 -60; J 
Dig Dis 2016;17:820 -828). How about AIM65 in predicting 30 -day mortality 
compare to pre -RS or full RS in their study population?  
 
4. Previous study showed these scoring system were less accurate in predicting outcome 
of patients with variceal bleeding (J Gastroenterol Hepatol 2016;31:761 -7). However, 
the author included patients with variceal bleeding. Will the result be different if the 
analyses were stratified by non -variceal vs. variceal bleeding?  
 
5. The selection of op timal cut -off is usually based on youden index, did the author 
select their optimal value based on it?  
 
Discussion  
 
1. The statement "However, RS is not suitable for an early decision on need of urgent 
interventions or predicting 30 -day mortality in the man agement of patients with 
UGIB, since it requires endoscopic finding" is not true since their data showed Pre -E 
RS is good at predicting 30 -day mortality. Moreover, they do not show the data of RS 
to predict 30 -day mortality. The statement should be modifie d. 
 
2. The author stated "Our results suggest that patients with GBS > 9 or mGBS > 9 need 
hemostatic interventions and have to undergo early gastroscopy". The author should 
provide data to show that in patients with GBS or mGBS > 9, a shorter presentation -
to-endoscopy time is related to a lower mortality.  
 
Reference:  
 
1. Some redundant words are seen in reference 5: Barkun AN, Bardou M, Kuipers EJ, 
Sung J, Hunt RH, Martel M, Sinclair P; International Consensus Upper 
Gastrointestinal Bleeding Conference Group . International Consensus Upper 
Gastrointestinal Bleeding Conference G. International consensus recommendations 
on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann 
Intern Med. 2010;152:101 -13. 
 
Are the methods 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 conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript  or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in a n organisation that 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 relat ion 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 interests  
 
I agree to the open peer review  policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted 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 wis h to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
assistant