Title: Low preoperative prealbumin predicts the prevalence of complications following liver
transplantation
Version: 2 Date: 13 Apr 2021
Reviewer's report:
Liver transplantation is currently the single most efficient and definitive treatment option in
patients with end-stage liver disease. Survival rates after surgery are over 80%, depending
on the post-transplant time. The number of post-transplant complications is directly related to
the nutritional status of this patient. Therefore, methods that assess the association between
pre-operative nutritional status indicators and postoperative complications in these patients are
essential to reduce negative clinical outcomes after transplantation. Among the biochemical
markers of the state is prealbumin, which, due to its short half-life, is more sensitive and specific
in response to nutritional reserves.
The authors aimed to verify whether prealbumin levels before transplantation are associated
with postoperative complications. However, some points need to be revised.
The authors had more than one objective, it may be necessary to expand, as I signaled at least
three:
1. Assess the association between preoperative prealbumin and postoperative complications.
2. Assess the correlation between preoperative albumin and prealbumin.
3. Assess the association between preoperative prealbumin levels and disease severity using
MELD.
In the methods, the inclusion and exclusion criteria were not included. In the limitations, it is
pointed out that prealbumin can be influenced by acute inflammation, hyperthyroidism, and
nephrotic syndrome, were these patients excluded?
The cutoff point for MELD was 15, which criterion was used to determine this value?
A discussion that should have been further investigated is why prealbumin in these patients may
be low.
An in-depth discussion needs to be made as to why there was an association between low levels
of prealbumin and a greater number of complications only in MELDs under 15.
An important finding was not discussed, the high mortality rate in patients with low prealbumin
in individuals with low MELD (Table 3).
On line 114, wouldn't it be creatinine?
In Table 4, in the header, high prealbumin or normal prealbumin?
What is the average postoperative time that complications were evaluated? Do the authors think
that shorter or longer time could interfere in the prevalence of complications? Similarly, what
is the average length of stay, could this data also interfere with the results?
What were the other indications for liver transplantation? 80.6% of patients had HBV infection,
could the indication interfere with prealbumin results and complications?
One suggestion: Prealbumin levels could be measured in conjunction with C-reactive protein as
it is an inflammation marker and therefore could help to distinguish between secondary decrease
due to acute inflammatory diseases or malnutrition.
Title: Low preoperative prealbumin predicts the prevalence of complications following liver
transplantation
Version: 2 Date: 13 Apr 2021
Reviewer's report:
Liver transplantation is currently the single most efficient and definitive treatment option in
patients with end-stage liver disease. Survival rates after surgery are over 80%, depending
on the post-transplant time. The number of post-transplant complications is directly related to
the nutritional status of this patient. Therefore, methods that assess the association between
pre-operative nutritional status indicators and postoperative complications in these patients are
essential to reduce negative clinical outcomes after transplantation. Among the biochemical
markers of the state is prealbumin, which, due to its short half-life, is more sensitive and specific
in response to nutritional reserves.
The authors aimed to verify whether prealbumin levels before transplantation are associated
with postoperative complications. However, some points need to be revised.
The authors had more than one objective, it may be necessary to expand, as I signaled at least
three:
1. Assess the association between preoperative prealbumin and postoperative complications.
2. Assess the correlation between preoperative albumin and prealbumin.
3. Assess the association between preoperative prealbumin levels and disease severity using
MELD.
In the methods, the inclusion and exclusion criteria were not included. In the limitations, it is
pointed out that prealbumin can be influenced by acute inflammation, hyperthyroidism, and
nephrotic syndrome, were these patients excluded?
The cutoff point for MELD was 15, which criterion was used to determine this value?
A discussion that should have been further investigated is why prealbumin in these patients may
be low.
An in-depth discussion needs to be made as to why there was an association between low levels
of prealbumin and a greater number of complications only in MELDs under 15.
An important finding was not discussed, the high mortality rate in patients with low prealbumin
in individuals with low MELD (Table 3).
On line 114, wouldn't it be creatinine?
In Table 4, in the header, high prealbumin or normal prealbumin?
What is the average postoperative time that complications were evaluated? Do the authors think
that shorter or longer time could interfere in the prevalence of complications? Similarly, what
is the average length of stay, could this data also interfere with the results?
What were the other indications for liver transplantation? 80.6% of patients had HBV infection,
could the indication interfere with prealbumin results and complications?
One suggestion: Prealbumin levels could be measured in conjunction with C-reactive protein as
it is an inflammation marker and therefore could help to distinguish between secondary decrease
due to acute inflammatory diseases or malnutrition.
Please review this paper.
user
Title: Low preoperative prealbumin predicts the prevalence of complications following liver
transplantation
Version: 2 Date: 13 Apr 2021
Reviewer's report:
Liver transplantation is currently the single most efficient and definitive treatment option in
patients with end-stage liver disease. Survival rates after surgery are over 80%, depending
on the post-transplant time. The number of post-transplant complications is directly related to
the nutritional status of this patient. Therefore, methods that assess the association between
pre-operative nutritional status indicators and postoperative complications in these patients are
essential to reduce negative clinical outcomes after transplantation. Among the biochemical
markers of the state is prealbumin, which, due to its short half-life, is more sensitive and specific
in response to nutritional reserves.
The authors aimed to verify whether prealbumin levels before transplantation are associated
with postoperative complications. However, some points need to be revised.
The authors had more than one objective, it may be necessary to expand, as I signaled at least
three:
1. Assess the association between preoperative prealbumin and postoperative complications.
2. Assess the correlation between preoperative albumin and prealbumin.
3. Assess the association between preoperative prealbumin levels and disease severity using
MELD.
In the methods, the inclusion and exclusion criteria were not included. In the limitations, it is
pointed out that prealbumin can be influenced by acute inflammation, hyperthyroidism, and
nephrotic syndrome, were these patients excluded?
The cutoff point for MELD was 15, which criterion was used to determine this value?
A discussion that should have been further investigated is why prealbumin in these patients may
be low.
An in-depth discussion needs to be made as to why there was an association between low levels
of prealbumin and a greater number of complications only in MELDs under 15.
An important finding was not discussed, the high mortality rate in patients with low prealbumin
in individuals with low MELD (Table 3).
On line 114, wouldn't it be creatinine?
In Table 4, in the header, high prealbumin or normal prealbumin?
What is the average postoperative time that complications were evaluated? Do the authors think
that shorter or longer time could interfere in the prevalence of complications? Similarly, what
is the average length of stay, could this data also interfere with the results?
What were the other indications for liver transplantation? 80.6% of patients had HBV infection,
could the indication interfere with prealbumin results and complications?
One suggestion: Prealbumin levels could be measured in conjunction with C-reactive protein as
it is an inflammation marker and therefore could help to distinguish between secondary decrease
due to acute inflammatory diseases or malnutrition.
assistant