Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 01 Mar 2025
Reviewer's report:
Thank you for the opportunity to review your manuscript. Overall, the study is well-conceived
and presents an innovative evaluation of the hemoglobin-to-RDW ratio (HRR) as a prognostic
marker for 180-day mortality in critically ill patients with gastrointestinal bleeding (GIB) using
the MIMIC-IV database. Your findings that higher HRR is associated with reduced mortality,
even after adjusting for multiple confounders, are intriguing and may have important clinical
implications. I appreciate the effort in exploring non-linear relationships through restricted
cubic spline (RCS) analysis, as well as the subgroup analyses that enhance the depth of the
investigation.
I have several comments and questions that I hope you can address in a revision:
1. Could you please specify how GIB was defined in your study? For instance, which ICD codes
were used to identify these patients, and have these codes been validated in previous research?
This clarification is essential for understanding the cohort selection and ensuring reproducibility.
2. Please elaborate on your RCS methodology. Specifically, how many knots were used, and
what criteria were applied for their placement? This detail is important to assess the robustness
of your non-linear modeling approach.
3. Have you considered applying a piecewise linear model with a single change point? Presenting
two different hazard ratios for segments before and after the change point could offer additional
insights into the relationship between HRR and mortality.
4. It appears that Figures 2 and 3 may be reversed. Could you confirm the intended order and
ensure that each figure is correctly labeled and referenced in the text?
5. The manuscript would benefit from a more detailed interpretation of the RCS findings. Could
you specify the approximate location of the changing point and explain the magnitude and
direction of the effect before and after this threshold?
6. In the limitations section, you mention selection and information biases. Could you provide
more detailed explanations regarding the sources of these biases and how they might influence
the study’s conclusions?
Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 01 Mar 2025
Reviewer's report:
Thank you for the opportunity to review your manuscript. Overall, the study is well-conceived
and presents an innovative evaluation of the hemoglobin-to-RDW ratio (HRR) as a prognostic
marker for 180-day mortality in critically ill patients with gastrointestinal bleeding (GIB) using
the MIMIC-IV database. Your findings that higher HRR is associated with reduced mortality,
even after adjusting for multiple confounders, are intriguing and may have important clinical
implications. I appreciate the effort in exploring non-linear relationships through restricted
cubic spline (RCS) analysis, as well as the subgroup analyses that enhance the depth of the
investigation.
I have several comments and questions that I hope you can address in a revision:
1. Could you please specify how GIB was defined in your study? For instance, which ICD codes
were used to identify these patients, and have these codes been validated in previous research?
This clarification is essential for understanding the cohort selection and ensuring reproducibility.
2. Please elaborate on your RCS methodology. Specifically, how many knots were used, and
what criteria were applied for their placement? This detail is important to assess the robustness
of your non-linear modeling approach.
3. Have you considered applying a piecewise linear model with a single change point? Presenting
two different hazard ratios for segments before and after the change point could offer additional
insights into the relationship between HRR and mortality.
4. It appears that Figures 2 and 3 may be reversed. Could you confirm the intended order and
ensure that each figure is correctly labeled and referenced in the text?
5. The manuscript would benefit from a more detailed interpretation of the RCS findings. Could
you specify the approximate location of the changing point and explain the magnitude and
direction of the effect before and after this threshold?
6. In the limitations section, you mention selection and information biases. Could you provide
more detailed explanations regarding the sources of these biases and how they might influence
the study’s conclusions?
Please review this paper.
user
Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 01 Mar 2025
Reviewer's report:
Thank you for the opportunity to review your manuscript. Overall, the study is well-conceived
and presents an innovative evaluation of the hemoglobin-to-RDW ratio (HRR) as a prognostic
marker for 180-day mortality in critically ill patients with gastrointestinal bleeding (GIB) using
the MIMIC-IV database. Your findings that higher HRR is associated with reduced mortality,
even after adjusting for multiple confounders, are intriguing and may have important clinical
implications. I appreciate the effort in exploring non-linear relationships through restricted
cubic spline (RCS) analysis, as well as the subgroup analyses that enhance the depth of the
investigation.
I have several comments and questions that I hope you can address in a revision:
1. Could you please specify how GIB was defined in your study? For instance, which ICD codes
were used to identify these patients, and have these codes been validated in previous research?
This clarification is essential for understanding the cohort selection and ensuring reproducibility.
2. Please elaborate on your RCS methodology. Specifically, how many knots were used, and
what criteria were applied for their placement? This detail is important to assess the robustness
of your non-linear modeling approach.
3. Have you considered applying a piecewise linear model with a single change point? Presenting
two different hazard ratios for segments before and after the change point could offer additional
insights into the relationship between HRR and mortality.
4. It appears that Figures 2 and 3 may be reversed. Could you confirm the intended order and
ensure that each figure is correctly labeled and referenced in the text?
5. The manuscript would benefit from a more detailed interpretation of the RCS findings. Could
you specify the approximate location of the changing point and explain the magnitude and
direction of the effect before and after this threshold?
6. In the limitations section, you mention selection and information biases. Could you provide
more detailed explanations regarding the sources of these biases and how they might influence
the study’s conclusions?
assistant