Reviewer's report
Title:Child-Pugh score is superior to model for end-stage liver disease score
(MELD) in predicting survival on and need for removal from waiting list in patients
awaiting liver transplantation
Version: 1Date:28 May 2009
Reviewer: Michael A Fink
Reviewer's report:
Major compulsory revisions:
1. The crux of the paper is the comparison of CTP and MELD score with respect
to prediction of waiting list mortality. The paper asserts that CTP is superior in
this regard. However, statistical analysis to support this is not presented. I think
that it is essential that the C-statistic for CTP and MELD are given and a P value
for the comparison be given.
2. Optimal cut-offs for CTP and MELD are given, but the method of determining
these is not described. This should be corrected.
3. The first 2 paragraphs of the discussion reproduce information contained in the
introduction. These should be removed from the paper. They could be replaced
by a very brief summary of the introduction.
4. Tables 5a and 5b do not contribute any substantial additional information and
are not further considered in the paper. They should be removed.
Minor essential revisions:
1. There are some minor grammatical issues that need to be corrected. For
example, Results page 1, last paragraph: "Of 29 patients died or removed..."
should read "Of 29 patients who died or were removed..."
2. Discussion page 1, 3rd paragraph: "In our study that compromised ..." should
read "In our study that comprised ..."
2. Discussion, page 2, 1st paragraph: "indicating, that patient with compensated
cirrhosis" should read "indicating that patients with compensated cirrhosis"
Discretionary revisions:
1. The mean MELD score of all patients in the study was 14.2. This seems
relatively low. It has previously been demonstrated that below a MELD score of
15, patients have a higher risk of death from transplantation than waiting list
death (Merion et al Am J Transpl 2005;5:307-13). This issue deserves some
consideration in the discussion.
2. The authors assert that other studies evaluating MELD and CTP "did not take
into account patients removed from the waiting list due to poor condition". In fact,
in one paper evaluating risk factors, including CTP and MELD, for waiting list
mortality, patients who were listed for transplantation and were removed from the
waiting list due to poor condition and subsequently died were included in the
waiting list mortality group (Fink et al. J Gastroenterol Hepatol. 2007;22:119-24)
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Child-Pugh score is superior to model for end-stage liver disease score
(MELD) in predicting survival on and need for removal from waiting list in patients
awaiting liver transplantation
Version: 1Date:28 May 2009
Reviewer: Michael A Fink
Reviewer's report:
Major compulsory revisions:
1. The crux of the paper is the comparison of CTP and MELD score with respect
to prediction of waiting list mortality. The paper asserts that CTP is superior in
this regard. However, statistical analysis to support this is not presented. I think
that it is essential that the C-statistic for CTP and MELD are given and a P value
for the comparison be given.
2. Optimal cut-offs for CTP and MELD are given, but the method of determining
these is not described. This should be corrected.
3. The first 2 paragraphs of the discussion reproduce information contained in the
introduction. These should be removed from the paper. They could be replaced
by a very brief summary of the introduction.
4. Tables 5a and 5b do not contribute any substantial additional information and
are not further considered in the paper. They should be removed.
Minor essential revisions:
1. There are some minor grammatical issues that need to be corrected. For
example, Results page 1, last paragraph: "Of 29 patients died or removed..."
should read "Of 29 patients who died or were removed..."
2. Discussion page 1, 3rd paragraph: "In our study that compromised ..." should
read "In our study that comprised ..."
2. Discussion, page 2, 1st paragraph: "indicating, that patient with compensated
cirrhosis" should read "indicating that patients with compensated cirrhosis"
Discretionary revisions:
1. The mean MELD score of all patients in the study was 14.2. This seems
relatively low. It has previously been demonstrated that below a MELD score of
15, patients have a higher risk of death from transplantation than waiting list
death (Merion et al Am J Transpl 2005;5:307-13). This issue deserves some
consideration in the discussion.
2. The authors assert that other studies evaluating MELD and CTP "did not take
into account patients removed from the waiting list due to poor condition". In fact,
in one paper evaluating risk factors, including CTP and MELD, for waiting list
mortality, patients who were listed for transplantation and were removed from the
waiting list due to poor condition and subsequently died were included in the
waiting list mortality group (Fink et al. J Gastroenterol Hepatol. 2007;22:119-24)
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Child-Pugh score is superior to model for end-stage liver disease score
(MELD) in predicting survival on and need for removal from waiting list in patients
awaiting liver transplantation
Version: 1Date:28 May 2009
Reviewer: Michael A Fink
Reviewer's report:
Major compulsory revisions:
1. The crux of the paper is the comparison of CTP and MELD score with respect
to prediction of waiting list mortality. The paper asserts that CTP is superior in
this regard. However, statistical analysis to support this is not presented. I think
that it is essential that the C-statistic for CTP and MELD are given and a P value
for the comparison be given.
2. Optimal cut-offs for CTP and MELD are given, but the method of determining
these is not described. This should be corrected.
3. The first 2 paragraphs of the discussion reproduce information contained in the
introduction. These should be removed from the paper. They could be replaced
by a very brief summary of the introduction.
4. Tables 5a and 5b do not contribute any substantial additional information and
are not further considered in the paper. They should be removed.
Minor essential revisions:
1. There are some minor grammatical issues that need to be corrected. For
example, Results page 1, last paragraph: "Of 29 patients died or removed..."
should read "Of 29 patients who died or were removed..."
2. Discussion page 1, 3rd paragraph: "In our study that compromised ..." should
read "In our study that comprised ..."
2. Discussion, page 2, 1st paragraph: "indicating, that patient with compensated
cirrhosis" should read "indicating that patients with compensated cirrhosis"
Discretionary revisions:
1. The mean MELD score of all patients in the study was 14.2. This seems
relatively low. It has previously been demonstrated that below a MELD score of
15, patients have a higher risk of death from transplantation than waiting list
death (Merion et al Am J Transpl 2005;5:307-13). This issue deserves some
consideration in the discussion.
2. The authors assert that other studies evaluating MELD and CTP "did not take
into account patients removed from the waiting list due to poor condition". In fact,
in one paper evaluating risk factors, including CTP and MELD, for waiting list
mortality, patients who were listed for transplantation and were removed from the
waiting list due to poor condition and subsequently died were included in the
waiting list mortality group (Fink et al. J Gastroenterol Hepatol. 2007;22:119-24)
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
assistant