Title: Correlation between systemic inflammatory response syndrome and prognosis of patients
with cirrhosis and hepatic encephalopathy
Version: 2 Date: 06 May 2025
Reviewer:  Iliana Mani
Reviewer's report:
Dear Editor
This is an interesting study, examining prevalence and significance of SIRS in cirrhotic patients
with encephalopathy. Although of clinical interest, this study faces some limitations. My main
concern is the methods applied for selection of patients.
Major comments
• Methods: More details are needed for the exclusion criterion “patients who were diagnosed
with serious primary conditions of other major systems” as it is too general.
• Patients management: This section describes a specific and homogenous method of identifying
and treating patients with HE. For example: “All patients were examined within 24 hours of
admission”, “If infection was suspected, samples for blood, urine and sputum cultures were
promptly collected”. However, as authors stated, the study is retrospective. How did authors
identify such information? Please clarify.
• Multivariate analysis: Although sodium was not of clinical significance in univariate analysis,
authors included it in multivariate analysis. Please explain or change accordingly.
Minor comments
• Abstract: In results, authors should provide information about total number of patients, their
demographic characteristics and markers of severity of liver disease such as MELD or Child
Pugh score.
• Introduction: Please rephrase
- “acute portal hypertension”
- "Among patients suffering decompensated cirrhosis, hepatic encephalopathy (HE) manifesting
with neuropsychiatric abnormalities is the most frequent complication" Please rephrase as HE
is not more common than ascites or variceal bleeding [D'Amico G et al. J Hepatol 2022
Jan;76(1):202-207]. Moreover, the provided references do not support such statement.
• Risk factors of death during hospitalization:  “Univariate and multivariate Cox”. Please
rephrase as multivariate analysis is mentioned separately.
• Please use were instead of was in “Correlations among significant variables was..."
Title: Correlation between systemic inflammatory response syndrome and prognosis of patients
with cirrhosis and hepatic encephalopathy
Version: 2 Date: 06 May 2025
Reviewer:  Iliana Mani
Reviewer's report:
Dear Editor
This is an interesting study, examining prevalence and significance of SIRS in cirrhotic patients
with encephalopathy. Although of clinical interest, this study faces some limitations. My main
concern is the methods applied for selection of patients.
Major comments
• Methods: More details are needed for the exclusion criterion “patients who were diagnosed
with serious primary conditions of other major systems” as it is too general.
• Patients management: This section describes a specific and homogenous method of identifying
and treating patients with HE. For example: “All patients were examined within 24 hours of
admission”, “If infection was suspected, samples for blood, urine and sputum cultures were
promptly collected”. However, as authors stated, the study is retrospective. How did authors
identify such information? Please clarify.
• Multivariate analysis: Although sodium was not of clinical significance in univariate analysis,
authors included it in multivariate analysis. Please explain or change accordingly.
Minor comments
• Abstract: In results, authors should provide information about total number of patients, their
demographic characteristics and markers of severity of liver disease such as MELD or Child
Pugh score.
• Introduction: Please rephrase
- “acute portal hypertension”
- "Among patients suffering decompensated cirrhosis, hepatic encephalopathy (HE) manifesting
with neuropsychiatric abnormalities is the most frequent complication" Please rephrase as HE
is not more common than ascites or variceal bleeding [D'Amico G et al. J Hepatol 2022
Jan;76(1):202-207]. Moreover, the provided references do not support such statement.
• Risk factors of death during hospitalization:  “Univariate and multivariate Cox”. Please
rephrase as multivariate analysis is mentioned separately.
• Please use were instead of was in “Correlations among significant variables was..."
Please review this paper.
user
Title: Correlation between systemic inflammatory response syndrome and prognosis of patients
with cirrhosis and hepatic encephalopathy
Version: 2 Date: 06 May 2025
Reviewer:  Iliana Mani
Reviewer's report:
Dear Editor
This is an interesting study, examining prevalence and significance of SIRS in cirrhotic patients
with encephalopathy. Although of clinical interest, this study faces some limitations. My main
concern is the methods applied for selection of patients.
Major comments
• Methods: More details are needed for the exclusion criterion “patients who were diagnosed
with serious primary conditions of other major systems” as it is too general.
• Patients management: This section describes a specific and homogenous method of identifying
and treating patients with HE. For example: “All patients were examined within 24 hours of
admission”, “If infection was suspected, samples for blood, urine and sputum cultures were
promptly collected”. However, as authors stated, the study is retrospective. How did authors
identify such information? Please clarify.
• Multivariate analysis: Although sodium was not of clinical significance in univariate analysis,
authors included it in multivariate analysis. Please explain or change accordingly.
Minor comments
• Abstract: In results, authors should provide information about total number of patients, their
demographic characteristics and markers of severity of liver disease such as MELD or Child
Pugh score.
• Introduction: Please rephrase
- “acute portal hypertension”
- "Among patients suffering decompensated cirrhosis, hepatic encephalopathy (HE) manifesting
with neuropsychiatric abnormalities is the most frequent complication" Please rephrase as HE
is not more common than ascites or variceal bleeding [D'Amico G et al. J Hepatol 2022
Jan;76(1):202-207]. Moreover, the provided references do not support such statement.
• Risk factors of death during hospitalization:  “Univariate and multivariate Cox”. Please
rephrase as multivariate analysis is mentioned separately.
• Please use were instead of was in “Correlations among significant variables was..."
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