Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 22 Feb 2025
Reviewer:  Toshiya Mitsunaga
Reviewer's report:
Thank you for giving the chance to review this research. It is very interesting to consider the
prediction of death by HRR, and I think that it may be possible to deepen our understanding
of the severity and pathology of severely ill patients in particular. In that respect, I believe that
this is an important study that evaluated the relationship between severe GIB patients and HRR.
However, I would like to point out some corrections before publishing.
[Major points]
1. The authors commented that the purpose of their study was to 'examine critically ill patients,'
but the inclusion criteria did not include any items indicating the severity of the condition, so
what kind of patients were they. Authors have to comment of severity score in inclusion criteria
(SOFA, APACH# et).
2. The authors state in their inclusion criteria that they had 'diagnosed GIB' but do not describe
how they made the diagnosis of GIB. It is better for the authors to comment on this point.
3. Patients with missing HRR information were excluded from this study, but cases with missing
values need to be treated appropriately and, in some cases, data should be repaired using multiple
imputation. The authors might want to comment on this point.
4. The authors only had  heart rate and SpO2 as vital sign information; however, studies on
prognostic assessment may benefit from including information on level of consciousness, blood
pressure, and temperature. Moreover, CRP should be included as laboratory data.
5. This is biggest problem that there was no comment of sample size calculation.
Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 22 Feb 2025
Reviewer:  Toshiya Mitsunaga
Reviewer's report:
Thank you for giving the chance to review this research. It is very interesting to consider the
prediction of death by HRR, and I think that it may be possible to deepen our understanding
of the severity and pathology of severely ill patients in particular. In that respect, I believe that
this is an important study that evaluated the relationship between severe GIB patients and HRR.
However, I would like to point out some corrections before publishing.
[Major points]
1. The authors commented that the purpose of their study was to 'examine critically ill patients,'
but the inclusion criteria did not include any items indicating the severity of the condition, so
what kind of patients were they. Authors have to comment of severity score in inclusion criteria
(SOFA, APACH# et).
2. The authors state in their inclusion criteria that they had 'diagnosed GIB' but do not describe
how they made the diagnosis of GIB. It is better for the authors to comment on this point.
3. Patients with missing HRR information were excluded from this study, but cases with missing
values need to be treated appropriately and, in some cases, data should be repaired using multiple
imputation. The authors might want to comment on this point.
4. The authors only had  heart rate and SpO2 as vital sign information; however, studies on
prognostic assessment may benefit from including information on level of consciousness, blood
pressure, and temperature. Moreover, CRP should be included as laboratory data.
5. This is biggest problem that there was no comment of sample size calculation.
Please review this paper.
user
Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 22 Feb 2025
Reviewer:  Toshiya Mitsunaga
Reviewer's report:
Thank you for giving the chance to review this research. It is very interesting to consider the
prediction of death by HRR, and I think that it may be possible to deepen our understanding
of the severity and pathology of severely ill patients in particular. In that respect, I believe that
this is an important study that evaluated the relationship between severe GIB patients and HRR.
However, I would like to point out some corrections before publishing.
[Major points]
1. The authors commented that the purpose of their study was to 'examine critically ill patients,'
but the inclusion criteria did not include any items indicating the severity of the condition, so
what kind of patients were they. Authors have to comment of severity score in inclusion criteria
(SOFA, APACH# et).
2. The authors state in their inclusion criteria that they had 'diagnosed GIB' but do not describe
how they made the diagnosis of GIB. It is better for the authors to comment on this point.
3. Patients with missing HRR information were excluded from this study, but cases with missing
values need to be treated appropriately and, in some cases, data should be repaired using multiple
imputation. The authors might want to comment on this point.
4. The authors only had  heart rate and SpO2 as vital sign information; however, studies on
prognostic assessment may benefit from including information on level of consciousness, blood
pressure, and temperature. Moreover, CRP should be included as laboratory data.
5. This is biggest problem that there was no comment of sample size calculation.
assistant