Title: Development and validation of the nomogram based on INR and eGFR for estimation of
mortality in patients with acute-on-chronic hepatitis B liver failure
Version: 0 Date: 10 Oct 2021
Reviewer's report:
The study by Shengnan Li and colleagues aimed to develop a prognostic score for predicting
28 and 90 day mortality in patients with hepatitis B related acute on chronic liver failure
patients. They included a retrospective cohort of patients to develop the nomogram for prediction
of mortality. Apart from this they used the decision curve analysis (DCA) to evaluate the
predictive accuracy and discriminative ability of the developed score. They performances
between nomograms and MELD, MELD-Na, albumin-bilirubin (ALBI) score were compared
using receiver operating characteristics curve (ROC). The study found eGFR as one of the
independent predictor. The strength is development of disease specific prognostic model.
However, there are several concerns which need to be addressed
1. Abstract- Needs to be rewritten. The abbreviations need to be spelled everywhere in the
abstract and main text. The aims and objectives should include primary and secondary outcome
measures and details of methods include the number in derivation and validation cohorts.
2. Introduction- Should also include the AARC score and other scores developed specifically
for HBV ACLF patients using the APASL definition and current need of new score. Limitations
of the existing scores.
3. Methods: How many patients underwent liver transplantation?. How was the data retrieved?
Was it from records, proforma or from HIS.  Why 7:3 allocation for derivation and validation
[the authors should quote reason or reference ) as this is not the standard approach. How was this
7:3 allocation performed. The language needs to be reformed for instance in exclusion criteria
words like “merged” with should be removed. Why did the authors choose to compare with
MELD and MELDNA scores which are not the standard scores for ACLF patients
4. Results: The authors have not mentioned the equation used for calculating eGFR.In table 1
more clinical details like ascites, HE, mean arterial pressure, AKI, MELD etc should be added
5. Discussion should detail and discuss the strengths and limitations of the current study.
Title: Development and validation of the nomogram based on INR and eGFR for estimation of
mortality in patients with acute-on-chronic hepatitis B liver failure
Version: 0 Date: 10 Oct 2021
Reviewer's report:
The study by Shengnan Li and colleagues aimed to develop a prognostic score for predicting
28 and 90 day mortality in patients with hepatitis B related acute on chronic liver failure
patients. They included a retrospective cohort of patients to develop the nomogram for prediction
of mortality. Apart from this they used the decision curve analysis (DCA) to evaluate the
predictive accuracy and discriminative ability of the developed score. They performances
between nomograms and MELD, MELD-Na, albumin-bilirubin (ALBI) score were compared
using receiver operating characteristics curve (ROC). The study found eGFR as one of the
independent predictor. The strength is development of disease specific prognostic model.
However, there are several concerns which need to be addressed
1. Abstract- Needs to be rewritten. The abbreviations need to be spelled everywhere in the
abstract and main text. The aims and objectives should include primary and secondary outcome
measures and details of methods include the number in derivation and validation cohorts.
2. Introduction- Should also include the AARC score and other scores developed specifically
for HBV ACLF patients using the APASL definition and current need of new score. Limitations
of the existing scores.
3. Methods: How many patients underwent liver transplantation?. How was the data retrieved?
Was it from records, proforma or from HIS.  Why 7:3 allocation for derivation and validation
[the authors should quote reason or reference ) as this is not the standard approach. How was this
7:3 allocation performed. The language needs to be reformed for instance in exclusion criteria
words like “merged” with should be removed. Why did the authors choose to compare with
MELD and MELDNA scores which are not the standard scores for ACLF patients
4. Results: The authors have not mentioned the equation used for calculating eGFR.In table 1
more clinical details like ascites, HE, mean arterial pressure, AKI, MELD etc should be added
5. Discussion should detail and discuss the strengths and limitations of the current study.
Please review this paper.
user
Title: Development and validation of the nomogram based on INR and eGFR for estimation of
mortality in patients with acute-on-chronic hepatitis B liver failure
Version: 0 Date: 10 Oct 2021
Reviewer's report:
The study by Shengnan Li and colleagues aimed to develop a prognostic score for predicting
28 and 90 day mortality in patients with hepatitis B related acute on chronic liver failure
patients. They included a retrospective cohort of patients to develop the nomogram for prediction
of mortality. Apart from this they used the decision curve analysis (DCA) to evaluate the
predictive accuracy and discriminative ability of the developed score. They performances
between nomograms and MELD, MELD-Na, albumin-bilirubin (ALBI) score were compared
using receiver operating characteristics curve (ROC). The study found eGFR as one of the
independent predictor. The strength is development of disease specific prognostic model.
However, there are several concerns which need to be addressed
1. Abstract- Needs to be rewritten. The abbreviations need to be spelled everywhere in the
abstract and main text. The aims and objectives should include primary and secondary outcome
measures and details of methods include the number in derivation and validation cohorts.
2. Introduction- Should also include the AARC score and other scores developed specifically
for HBV ACLF patients using the APASL definition and current need of new score. Limitations
of the existing scores.
3. Methods: How many patients underwent liver transplantation?. How was the data retrieved?
Was it from records, proforma or from HIS.  Why 7:3 allocation for derivation and validation
[the authors should quote reason or reference ) as this is not the standard approach. How was this
7:3 allocation performed. The language needs to be reformed for instance in exclusion criteria
words like “merged” with should be removed. Why did the authors choose to compare with
MELD and MELDNA scores which are not the standard scores for ACLF patients
4. Results: The authors have not mentioned the equation used for calculating eGFR.In table 1
more clinical details like ascites, HE, mean arterial pressure, AKI, MELD etc should be added
5. Discussion should detail and discuss the strengths and limitations of the current study.
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