Title: Prognostic Value of the International Normalized Ratio to Albumin Ratio in Acute
Pancreatitis: Insights from MIMIC-IV Database
Version: 2 Date: 16 Jun 2025
Reviewer's report:
I highly appreciate the authors’ careful and sincere responses to the reviewers’ comments.
The revisions were well-considered and have significantly improved the manuscript’s clarity,
transparency, and methodological rigor.
One of the most commendable aspects of the revised manuscript is the authors’ effort to
conduct external validation of the PTAR cutoff value (0.58) using the eICU-CRD database.
This appropriately addresses potential overfitting concerns associated with deriving and testing
the threshold within the same cohort, and it strengthens the generalizability of the findings.
The consistent and statistically significant results across multiple models further support the
robustness of the proposed cutoff.
Additionally, the authors have clearly addressed my previous concerns regarding the restricted
cubic spline (RCS) analysis. They have specified the use of a Cox proportional hazards model
with three knots placed at the 10th, 50th, and 90th percentiles, and employed likelihood ratio
tests via the anova function in the rms package to assess both overall and nonlinear associations.
Their rationale for using the likelihood ratio test instead of the Wald test is statistically sound
and appropriate for the analysis conducted.
The revised Figure 4 is now well-annotated and clearly interpretable, and it aligns well with the
clinical narrative presented in the manuscript. Overall, the study now demonstrates improved
clarity, methodological transparency, and scientific validity.
I have no further suggestions. I recommend this manuscript for acceptance in its current form.
Title: Prognostic Value of the International Normalized Ratio to Albumin Ratio in Acute
Pancreatitis: Insights from MIMIC-IV Database
Version: 2 Date: 16 Jun 2025
Reviewer's report:
I highly appreciate the authors’ careful and sincere responses to the reviewers’ comments.
The revisions were well-considered and have significantly improved the manuscript’s clarity,
transparency, and methodological rigor.
One of the most commendable aspects of the revised manuscript is the authors’ effort to
conduct external validation of the PTAR cutoff value (0.58) using the eICU-CRD database.
This appropriately addresses potential overfitting concerns associated with deriving and testing
the threshold within the same cohort, and it strengthens the generalizability of the findings.
The consistent and statistically significant results across multiple models further support the
robustness of the proposed cutoff.
Additionally, the authors have clearly addressed my previous concerns regarding the restricted
cubic spline (RCS) analysis. They have specified the use of a Cox proportional hazards model
with three knots placed at the 10th, 50th, and 90th percentiles, and employed likelihood ratio
tests via the anova function in the rms package to assess both overall and nonlinear associations.
Their rationale for using the likelihood ratio test instead of the Wald test is statistically sound
and appropriate for the analysis conducted.
The revised Figure 4 is now well-annotated and clearly interpretable, and it aligns well with the
clinical narrative presented in the manuscript. Overall, the study now demonstrates improved
clarity, methodological transparency, and scientific validity.
I have no further suggestions. I recommend this manuscript for acceptance in its current form.
Please review this paper.
user
Title: Prognostic Value of the International Normalized Ratio to Albumin Ratio in Acute
Pancreatitis: Insights from MIMIC-IV Database
Version: 2 Date: 16 Jun 2025
Reviewer's report:
I highly appreciate the authors’ careful and sincere responses to the reviewers’ comments.
The revisions were well-considered and have significantly improved the manuscript’s clarity,
transparency, and methodological rigor.
One of the most commendable aspects of the revised manuscript is the authors’ effort to
conduct external validation of the PTAR cutoff value (0.58) using the eICU-CRD database.
This appropriately addresses potential overfitting concerns associated with deriving and testing
the threshold within the same cohort, and it strengthens the generalizability of the findings.
The consistent and statistically significant results across multiple models further support the
robustness of the proposed cutoff.
Additionally, the authors have clearly addressed my previous concerns regarding the restricted
cubic spline (RCS) analysis. They have specified the use of a Cox proportional hazards model
with three knots placed at the 10th, 50th, and 90th percentiles, and employed likelihood ratio
tests via the anova function in the rms package to assess both overall and nonlinear associations.
Their rationale for using the likelihood ratio test instead of the Wald test is statistically sound
and appropriate for the analysis conducted.
The revised Figure 4 is now well-annotated and clearly interpretable, and it aligns well with the
clinical narrative presented in the manuscript. Overall, the study now demonstrates improved
clarity, methodological transparency, and scientific validity.
I have no further suggestions. I recommend this manuscript for acceptance in its current form.
assistant