Title: Association between lactate-to-albumin ratio and all-cause mortality in critically
ill cirrhotic patients with sepsis: A retrospective analysis of the MIMIC-IV database
Version: 1 Date: 11 Dec 2024
Reviewer's report:
Thank you for the opportunity to review this interesting work.
I believe that this work is suitable for publication, but some clarifications and minor
improvements would help enhance the quality of this work.
Specific Comments:
Lines 137-139 : Please add a reference for Multiple Imputation here. What type of multiple
imputation was used? How many iterations? And, did you only use one dataset, or were multiple
datasets imputed and then combined for analysis? I would like to see some more detail here.
Lines 142-145 : If a patient died at day 45, would they be censored for the analysis of the 30-
day death, but then included in the analysis of 90 & 180-day death? If so, then it may be more
simple to just analyze survival up to 180-days. You could still calculate mortality rates at 30,
90, and 180 days, this would just be less redundant.
Lines 153-154 : Did you assess proportional hazards assumption for Cox model? Also, liver
transplant could be a competing risk to mortality here – did you look at LT rates between the
quantiles of LAR?
Line 169 : Can you add more detail on this “recursive algorithm?”
Other General Comments:
-In all instances, change the word “multivariate” to “multivariable.”
-Lines 143, 144, 184, 276 : The word “enrolled” is not correct here – this was a retrospective
cohort study where you pulled info from a database – “enrolled” would be more suitable for a
prospective study or clinical trial where you were able to screen each patient before entering
them into the study.
-Figure 3 needs more clarification, it is somewhat confusing as-is. What do the red lines in the
top three panels represent?
-I think it would be interesting to see how LAR compares to lactate alone or albumin alone in
this cohort. Can you see if replacing LAR with lactate/albumin individually provides a better
fit? Or – even better, if you have access to an independent cohort (or even the same database
at a different time period than that used in your main analysis), you could compare the AUCs
and predictive performance.
If not, this is fine, but this analysis would help strengthen the argument that LAR is a superior
predictor.
Title: Association between lactate-to-albumin ratio and all-cause mortality in critically
ill cirrhotic patients with sepsis: A retrospective analysis of the MIMIC-IV database
Version: 1 Date: 11 Dec 2024
Reviewer's report:
Thank you for the opportunity to review this interesting work.
I believe that this work is suitable for publication, but some clarifications and minor
improvements would help enhance the quality of this work.
Specific Comments:
Lines 137-139 : Please add a reference for Multiple Imputation here. What type of multiple
imputation was used? How many iterations? And, did you only use one dataset, or were multiple
datasets imputed and then combined for analysis? I would like to see some more detail here.
Lines 142-145 : If a patient died at day 45, would they be censored for the analysis of the 30-
day death, but then included in the analysis of 90 & 180-day death? If so, then it may be more
simple to just analyze survival up to 180-days. You could still calculate mortality rates at 30,
90, and 180 days, this would just be less redundant.
Lines 153-154 : Did you assess proportional hazards assumption for Cox model? Also, liver
transplant could be a competing risk to mortality here – did you look at LT rates between the
quantiles of LAR?
Line 169 : Can you add more detail on this “recursive algorithm?”
Other General Comments:
-In all instances, change the word “multivariate” to “multivariable.”
-Lines 143, 144, 184, 276 : The word “enrolled” is not correct here – this was a retrospective
cohort study where you pulled info from a database – “enrolled” would be more suitable for a
prospective study or clinical trial where you were able to screen each patient before entering
them into the study.
-Figure 3 needs more clarification, it is somewhat confusing as-is. What do the red lines in the
top three panels represent?
-I think it would be interesting to see how LAR compares to lactate alone or albumin alone in
this cohort. Can you see if replacing LAR with lactate/albumin individually provides a better
fit? Or – even better, if you have access to an independent cohort (or even the same database
at a different time period than that used in your main analysis), you could compare the AUCs
and predictive performance.
If not, this is fine, but this analysis would help strengthen the argument that LAR is a superior
predictor.
Please review this paper.
user
Title: Association between lactate-to-albumin ratio and all-cause mortality in critically
ill cirrhotic patients with sepsis: A retrospective analysis of the MIMIC-IV database
Version: 1 Date: 11 Dec 2024
Reviewer's report:
Thank you for the opportunity to review this interesting work.
I believe that this work is suitable for publication, but some clarifications and minor
improvements would help enhance the quality of this work.
Specific Comments:
Lines 137-139 : Please add a reference for Multiple Imputation here. What type of multiple
imputation was used? How many iterations? And, did you only use one dataset, or were multiple
datasets imputed and then combined for analysis? I would like to see some more detail here.
Lines 142-145 : If a patient died at day 45, would they be censored for the analysis of the 30-
day death, but then included in the analysis of 90 & 180-day death? If so, then it may be more
simple to just analyze survival up to 180-days. You could still calculate mortality rates at 30,
90, and 180 days, this would just be less redundant.
Lines 153-154 : Did you assess proportional hazards assumption for Cox model? Also, liver
transplant could be a competing risk to mortality here – did you look at LT rates between the
quantiles of LAR?
Line 169 : Can you add more detail on this “recursive algorithm?”
Other General Comments:
-In all instances, change the word “multivariate” to “multivariable.”
-Lines 143, 144, 184, 276 : The word “enrolled” is not correct here – this was a retrospective
cohort study where you pulled info from a database – “enrolled” would be more suitable for a
prospective study or clinical trial where you were able to screen each patient before entering
them into the study.
-Figure 3 needs more clarification, it is somewhat confusing as-is. What do the red lines in the
top three panels represent?
-I think it would be interesting to see how LAR compares to lactate alone or albumin alone in
this cohort. Can you see if replacing LAR with lactate/albumin individually provides a better
fit? Or – even better, if you have access to an independent cohort (or even the same database
at a different time period than that used in your main analysis), you could compare the AUCs
and predictive performance.
If not, this is fine, but this analysis would help strengthen the argument that LAR is a superior
predictor.
assistant