Title: Increased intra-abdominal pressure linked to worse long-term prognosis among patients
with orthotopic liver transplantation: A retrospective, observational study
Version: 2 Date: 17 Jan 2025
Reviewer's report:
I am grateful for the opportunity to contribute to this compelling research. This study provides
valuable insights into the surgical outcomes of more than 380 liver transplants performed at
a single institution in China. The significance of this study lies in its innovative approach,
combining intra-abdominal hypertension (IAH) and the SOFA score as risk factors to predict
postoperative mortality. The detailed analysis of ICU data following liver transplantation is
commendable. However, while the study draws intriguing conclusions, there remains room for
further refinement.
1. Study Period and Outcome Measures
The study period for the target cases spans from January 2018 to March 2022. I believe the
observation period is insufficient to use 5-year survival as the primary outcome measure.
I recommend revising the outcome to either 3-month or 1-year survival, as these are more
appropriate given the available follow-up duration.
2. Donor Information in Prognostic Analysis
One key cause of intra-abdominal hypertension is a mismatch between graft size and recipient
physique (e.g., body surface area or BMI). However, Table 1 does not include donor-related
information. I suggest incorporating donor characteristics, including donor age, which is widely
recognized as a critical prognostic factor. It would be prudent to include donor age in the
multivariate analysis to enhance the robustness of the prognostic evaluation.
3. Univariate Analysis Results for Cox Regression (Figure 2)
In Figure 2, the authors perform a multivariate Cox regression analysis of overall survival (OS).
Given the small number of events (n=24), the study notes that factors were selected through a
stepwise approach as Figure 3. However, the univariate analysis results for all factors should
be presented alongside Figure 2 to provide transparency regarding the selection process and to
support the multivariate analysis.
4. AUC of SOFA Score (Figure 3)
In Figure 3, the SOFA score alone achieves a high AUC of 0.830, demonstrating strong
predictive power. Adding intra-abdominal pressure (IAP) results in only a marginal increase
to 0.834, which likely lacks statistical significance. This suggests that the simpler SOFA score
alone may be sufficient as a predictive tool.
5. Stratification of OS Risk Using Combined Factors
If the authors believe that combining IAH and the SOFA score offers added predictive value,
it is essential to present additional data supporting this claim. As both factors are identified as
independent risk factors for OS in the Cox regression analysis, devising a method to illustrate risk
stratification using these two factors would strengthen the argument. For instance, KM curves
according to these predictive factors or the cubic spline curves could visually demonstrate how
these factors interact to predict OS outcomes more effectively and determine the cut-off levels
of IAH.
Title: Increased intra-abdominal pressure linked to worse long-term prognosis among patients
with orthotopic liver transplantation: A retrospective, observational study
Version: 2 Date: 17 Jan 2025
Reviewer's report:
I am grateful for the opportunity to contribute to this compelling research. This study provides
valuable insights into the surgical outcomes of more than 380 liver transplants performed at
a single institution in China. The significance of this study lies in its innovative approach,
combining intra-abdominal hypertension (IAH) and the SOFA score as risk factors to predict
postoperative mortality. The detailed analysis of ICU data following liver transplantation is
commendable. However, while the study draws intriguing conclusions, there remains room for
further refinement.
1. Study Period and Outcome Measures
The study period for the target cases spans from January 2018 to March 2022. I believe the
observation period is insufficient to use 5-year survival as the primary outcome measure.
I recommend revising the outcome to either 3-month or 1-year survival, as these are more
appropriate given the available follow-up duration.
2. Donor Information in Prognostic Analysis
One key cause of intra-abdominal hypertension is a mismatch between graft size and recipient
physique (e.g., body surface area or BMI). However, Table 1 does not include donor-related
information. I suggest incorporating donor characteristics, including donor age, which is widely
recognized as a critical prognostic factor. It would be prudent to include donor age in the
multivariate analysis to enhance the robustness of the prognostic evaluation.
3. Univariate Analysis Results for Cox Regression (Figure 2)
In Figure 2, the authors perform a multivariate Cox regression analysis of overall survival (OS).
Given the small number of events (n=24), the study notes that factors were selected through a
stepwise approach as Figure 3. However, the univariate analysis results for all factors should
be presented alongside Figure 2 to provide transparency regarding the selection process and to
support the multivariate analysis.
4. AUC of SOFA Score (Figure 3)
In Figure 3, the SOFA score alone achieves a high AUC of 0.830, demonstrating strong
predictive power. Adding intra-abdominal pressure (IAP) results in only a marginal increase
to 0.834, which likely lacks statistical significance. This suggests that the simpler SOFA score
alone may be sufficient as a predictive tool.
5. Stratification of OS Risk Using Combined Factors
If the authors believe that combining IAH and the SOFA score offers added predictive value,
it is essential to present additional data supporting this claim. As both factors are identified as
independent risk factors for OS in the Cox regression analysis, devising a method to illustrate risk
stratification using these two factors would strengthen the argument. For instance, KM curves
according to these predictive factors or the cubic spline curves could visually demonstrate how
these factors interact to predict OS outcomes more effectively and determine the cut-off levels
of IAH.
Please review this paper.
user
Title: Increased intra-abdominal pressure linked to worse long-term prognosis among patients
with orthotopic liver transplantation: A retrospective, observational study
Version: 2 Date: 17 Jan 2025
Reviewer's report:
I am grateful for the opportunity to contribute to this compelling research. This study provides
valuable insights into the surgical outcomes of more than 380 liver transplants performed at
a single institution in China. The significance of this study lies in its innovative approach,
combining intra-abdominal hypertension (IAH) and the SOFA score as risk factors to predict
postoperative mortality. The detailed analysis of ICU data following liver transplantation is
commendable. However, while the study draws intriguing conclusions, there remains room for
further refinement.
1. Study Period and Outcome Measures
The study period for the target cases spans from January 2018 to March 2022. I believe the
observation period is insufficient to use 5-year survival as the primary outcome measure.
I recommend revising the outcome to either 3-month or 1-year survival, as these are more
appropriate given the available follow-up duration.
2. Donor Information in Prognostic Analysis
One key cause of intra-abdominal hypertension is a mismatch between graft size and recipient
physique (e.g., body surface area or BMI). However, Table 1 does not include donor-related
information. I suggest incorporating donor characteristics, including donor age, which is widely
recognized as a critical prognostic factor. It would be prudent to include donor age in the
multivariate analysis to enhance the robustness of the prognostic evaluation.
3. Univariate Analysis Results for Cox Regression (Figure 2)
In Figure 2, the authors perform a multivariate Cox regression analysis of overall survival (OS).
Given the small number of events (n=24), the study notes that factors were selected through a
stepwise approach as Figure 3. However, the univariate analysis results for all factors should
be presented alongside Figure 2 to provide transparency regarding the selection process and to
support the multivariate analysis.
4. AUC of SOFA Score (Figure 3)
In Figure 3, the SOFA score alone achieves a high AUC of 0.830, demonstrating strong
predictive power. Adding intra-abdominal pressure (IAP) results in only a marginal increase
to 0.834, which likely lacks statistical significance. This suggests that the simpler SOFA score
alone may be sufficient as a predictive tool.
5. Stratification of OS Risk Using Combined Factors
If the authors believe that combining IAH and the SOFA score offers added predictive value,
it is essential to present additional data supporting this claim. As both factors are identified as
independent risk factors for OS in the Cox regression analysis, devising a method to illustrate risk
stratification using these two factors would strengthen the argument. For instance, KM curves
according to these predictive factors or the cubic spline curves could visually demonstrate how
these factors interact to predict OS outcomes more effectively and determine the cut-off levels
of IAH.
assistant