Title: Identification of Early Predictors for Infected Necrosis in Acute Pancreatitis
Version: 1 Date: 16 May 2022
Reviewer's report:
The authors have tried to address an important research question: “prediction of infected necrosis
in patient with necrotizing pancreatitis”. Please find my comments.
Major Comments
1. The authors took a heterogeneous population for analysis. The study population was
patient with necrotizing pancreatitis requiring intervention such as aspiration and drainage. A
substantial proportion of patients with infected necrosis improve with antibiotics only (PMID
20417724) which were not included. Patients with acute on chronic pancreatitis also included.
2. Patients were classified to have infected necrosis on the basis of positive report on gram
stain or culture. However if a patient had undergone multiple interventions, any one positive
culture was classified as infected necrosis. Thus patients with initial sterile collection which got
infected after intervention also included erroneously. Patients with suspected infected necrosis
i.e. ongoing sepsis and/or worsening organ failure in a patient with necrotizing pancreatitis were
not included.
3. Though the authors have tried to include all plausible factors for prediction of infection in
necrotizing pancreatitis following important factors were missing:
a. Presence of organ failure in the first two weeks of illness (It is different from organ failure
developing after infection has set in. This parameter simply denotes severity of initial systemic
inflammation which may be reciprocated by an equally severe compensated anti-inflammatory
response resulting in infection of necrotic bed)
b. Extent of necrosis
It was not clear whether the lab parameters included in analysis were prior to infection or
after that. Since the factors which came out to be significant like CRP, albumin, creatinine can
be deranged in a patient with ongoing infection. The readers will be more interested in these
parameters at the baseline i.e. within first two weeks of illness prior to initiation of infective
cascade.
Minor comments
1. The sample size is small to predict a model
2. Usually 2/3rd of all necrotizing pancreatitis is sterile and 1/3rd get infected. However the
study shows 59 infected and 30 sterile pancreatitis which may be due to selection of patients
who have undergone intervention only. This should be highlighted in the discussion.
Title: Identification of Early Predictors for Infected Necrosis in Acute Pancreatitis
Version: 1 Date: 16 May 2022
Reviewer's report:
The authors have tried to address an important research question: “prediction of infected necrosis
in patient with necrotizing pancreatitis”. Please find my comments.
Major Comments
1. The authors took a heterogeneous population for analysis. The study population was
patient with necrotizing pancreatitis requiring intervention such as aspiration and drainage. A
substantial proportion of patients with infected necrosis improve with antibiotics only (PMID
20417724) which were not included. Patients with acute on chronic pancreatitis also included.
2. Patients were classified to have infected necrosis on the basis of positive report on gram
stain or culture. However if a patient had undergone multiple interventions, any one positive
culture was classified as infected necrosis. Thus patients with initial sterile collection which got
infected after intervention also included erroneously. Patients with suspected infected necrosis
i.e. ongoing sepsis and/or worsening organ failure in a patient with necrotizing pancreatitis were
not included.
3. Though the authors have tried to include all plausible factors for prediction of infection in
necrotizing pancreatitis following important factors were missing:
a. Presence of organ failure in the first two weeks of illness (It is different from organ failure
developing after infection has set in. This parameter simply denotes severity of initial systemic
inflammation which may be reciprocated by an equally severe compensated anti-inflammatory
response resulting in infection of necrotic bed)
b. Extent of necrosis
It was not clear whether the lab parameters included in analysis were prior to infection or
after that. Since the factors which came out to be significant like CRP, albumin, creatinine can
be deranged in a patient with ongoing infection. The readers will be more interested in these
parameters at the baseline i.e. within first two weeks of illness prior to initiation of infective
cascade.
Minor comments
1. The sample size is small to predict a model
2. Usually 2/3rd of all necrotizing pancreatitis is sterile and 1/3rd get infected. However the
study shows 59 infected and 30 sterile pancreatitis which may be due to selection of patients
who have undergone intervention only. This should be highlighted in the discussion.
Please review this paper.
user
Title: Identification of Early Predictors for Infected Necrosis in Acute Pancreatitis
Version: 1 Date: 16 May 2022
Reviewer's report:
The authors have tried to address an important research question: “prediction of infected necrosis
in patient with necrotizing pancreatitis”. Please find my comments.
Major Comments
1. The authors took a heterogeneous population for analysis. The study population was
patient with necrotizing pancreatitis requiring intervention such as aspiration and drainage. A
substantial proportion of patients with infected necrosis improve with antibiotics only (PMID
20417724) which were not included. Patients with acute on chronic pancreatitis also included.
2. Patients were classified to have infected necrosis on the basis of positive report on gram
stain or culture. However if a patient had undergone multiple interventions, any one positive
culture was classified as infected necrosis. Thus patients with initial sterile collection which got
infected after intervention also included erroneously. Patients with suspected infected necrosis
i.e. ongoing sepsis and/or worsening organ failure in a patient with necrotizing pancreatitis were
not included.
3. Though the authors have tried to include all plausible factors for prediction of infection in
necrotizing pancreatitis following important factors were missing:
a. Presence of organ failure in the first two weeks of illness (It is different from organ failure
developing after infection has set in. This parameter simply denotes severity of initial systemic
inflammation which may be reciprocated by an equally severe compensated anti-inflammatory
response resulting in infection of necrotic bed)
b. Extent of necrosis
It was not clear whether the lab parameters included in analysis were prior to infection or
after that. Since the factors which came out to be significant like CRP, albumin, creatinine can
be deranged in a patient with ongoing infection. The readers will be more interested in these
parameters at the baseline i.e. within first two weeks of illness prior to initiation of infective
cascade.
Minor comments
1. The sample size is small to predict a model
2. Usually 2/3rd of all necrotizing pancreatitis is sterile and 1/3rd get infected. However the
study shows 59 infected and 30 sterile pancreatitis which may be due to selection of patients
who have undergone intervention only. This should be highlighted in the discussion.
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