Reviewer ’s report  
 
Title: High incidence of hepatocellular carcinoma and cirrhotic  complications in patients with 
psychiatric illness: A territory -wide cohort study  
 
Version: 1 Date: 05 Apr 2020  
 
Reviewer: Hyun Woong Lee  
 
Reviewer's report:  
 
Dear Authors  
 
"High incidence of hepatocellular carcinoma and cirrhotic complications in patients with 
psychiatric illness: A territory -wide cohort study". This is a study to study the incidence of 
hepatoce llular carcinoma (HCC) and cirrhotic complications in psychiatric patients. This is a 
well written paper that tries to understand the epidemiology of chronic liver diseases among 
patients with psychiatric illness  
 
There is major problem that should be addre ss 
 
According to the author's data, the cumulative incidence of liver -related events is common in 
psychiatric patients. However, most liver -related events are associated with alcohol -induced 
mental disorder or drug -induced mental disorder.  
 
 I think the eti ologies of liver -related events are HCV infection in patients with drug -induced 
mental disorder, and alcoholic liver injury in patients with alcohol -induced mental disorder. 
Therefore, I think psychiatric illness might not be associated with liver related events.  
 
If authors want this hypothesis to be acceptable, authors have to describe the proportion of HCV 
infection and alcohol intake in the general Hong Kong Population.  
 
The authors have to compare the cumulative incidence of liver -related events between 
comparable ratio of viral infection and alcohol history in both two groups (general population vs. 
population with psychiatric illness).  
 
Please show these data in the Table. However, if it is impossible, please mention this limitation 
in the discussion.  
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat 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 relation 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 f or 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 Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded 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: High incidence of hepatocellular carcinoma and cirrhotic  complications in patients with 
psychiatric illness: A territory -wide cohort study  
 
Version: 1 Date: 05 Apr 2020  
 
Reviewer: Hyun Woong Lee  
 
Reviewer's report:  
 
Dear Authors  
 
"High incidence of hepatocellular carcinoma and cirrhotic complications in patients with 
psychiatric illness: A territory -wide cohort study". This is a study to study the incidence of 
hepatoce llular carcinoma (HCC) and cirrhotic complications in psychiatric patients. This is a 
well written paper that tries to understand the epidemiology of chronic liver diseases among 
patients with psychiatric illness  
 
There is major problem that should be addre ss 
 
According to the author's data, the cumulative incidence of liver -related events is common in 
psychiatric patients. However, most liver -related events are associated with alcohol -induced 
mental disorder or drug -induced mental disorder.  
 
 I think the eti ologies of liver -related events are HCV infection in patients with drug -induced 
mental disorder, and alcoholic liver injury in patients with alcohol -induced mental disorder. 
Therefore, I think psychiatric illness might not be associated with liver related events.  
 
If authors want this hypothesis to be acceptable, authors have to describe the proportion of HCV 
infection and alcohol intake in the general Hong Kong Population.  
 
The authors have to compare the cumulative incidence of liver -related events between 
comparable ratio of viral infection and alcohol history in both two groups (general population vs. 
population with psychiatric illness).  
 
Please show these data in the Table. However, if it is impossible, please mention this limitation 
in the discussion.  
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat 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 relation 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 f or 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 Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded 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: High incidence of hepatocellular carcinoma and cirrhotic  complications in patients with 
psychiatric illness: A territory -wide cohort study  
 
Version: 1 Date: 05 Apr 2020  
 
Reviewer: Hyun Woong Lee  
 
Reviewer's report:  
 
Dear Authors  
 
"High incidence of hepatocellular carcinoma and cirrhotic complications in patients with 
psychiatric illness: A territory -wide cohort study". This is a study to study the incidence of 
hepatoce llular carcinoma (HCC) and cirrhotic complications in psychiatric patients. This is a 
well written paper that tries to understand the epidemiology of chronic liver diseases among 
patients with psychiatric illness  
 
There is major problem that should be addre ss 
 
According to the author's data, the cumulative incidence of liver -related events is common in 
psychiatric patients. However, most liver -related events are associated with alcohol -induced 
mental disorder or drug -induced mental disorder.  
 
 I think the eti ologies of liver -related events are HCV infection in patients with drug -induced 
mental disorder, and alcoholic liver injury in patients with alcohol -induced mental disorder. 
Therefore, I think psychiatric illness might not be associated with liver related events.  
 
If authors want this hypothesis to be acceptable, authors have to describe the proportion of HCV 
infection and alcohol intake in the general Hong Kong Population.  
 
The authors have to compare the cumulative incidence of liver -related events between 
comparable ratio of viral infection and alcohol history in both two groups (general population vs. 
population with psychiatric illness).  
 
Please show these data in the Table. However, if it is impossible, please mention this limitation 
in the discussion.  
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat 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 relation 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 f or 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 Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant