Reviewer ’s report  
 
Title: Association between acute gastrointestinal injury and biomarkers of intestinal barrier  
function in critically ill patients  
 
Version: 0 Date: 14 Dec 2016  
 
Reviewer: Tatsuo Kanda  
 
Reviewer's report:  
 
GENERAL  
 
This is a prospective study that explored the association between biomarkers and acute 
gastrointestinal injury (AGI) in critically ill patients. By analyzing 90 patients in the intensive 
care unit (ICU) of their i nstitution, the authors concluded that D -lactate was a better biomarker 
for AGI than other blood markers. Although the present study included many analyses, the study 
design was obscure. Furthermore, the authors did not show any data indicating how D -lacta te 
measurement should be used in practice and to what extent the AGI diagnosis would be 
improved in quality by using this biomarker. For these reasons, this reviewer thinks the present 
manuscript is not worth publishing in BMC Gastroenterology.  
 
 
 
 
SPECIFIC  
 
1. This reviewer could not find human I -FABP ELISA in BioRad's product line -up. The 
authors should show the code in the catalogue.  
 
 
 
2. The D -lactate cutoff level should be clearly shown.  
 
 
 
3. In the AGI grade estimation, the odds by using D -lactate measurement were as small as 
1.059 for grade II, 1.155 for grade III, and 1.088 for grade IV, although statistically 
significant. This reviewer thinks the results suggested that D -lactate measurem ent was 
clinically inapplicable to AGI grade estimation.  
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which contro ls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of compe ting interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially  from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If you r reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
   
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/ licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Association between acute gastrointestinal injury and biomarkers of intestinal barrier  
function in critically ill patients  
 
Version: 0 Date: 14 Dec 2016  
 
Reviewer: Tatsuo Kanda  
 
Reviewer's report:  
 
GENERAL  
 
This is a prospective study that explored the association between biomarkers and acute 
gastrointestinal injury (AGI) in critically ill patients. By analyzing 90 patients in the intensive 
care unit (ICU) of their i nstitution, the authors concluded that D -lactate was a better biomarker 
for AGI than other blood markers. Although the present study included many analyses, the study 
design was obscure. Furthermore, the authors did not show any data indicating how D -lacta te 
measurement should be used in practice and to what extent the AGI diagnosis would be 
improved in quality by using this biomarker. For these reasons, this reviewer thinks the present 
manuscript is not worth publishing in BMC Gastroenterology.  
 
 
 
 
SPECIFIC  
 
1. This reviewer could not find human I -FABP ELISA in BioRad's product line -up. The 
authors should show the code in the catalogue.  
 
 
 
2. The D -lactate cutoff level should be clearly shown.  
 
 
 
3. In the AGI grade estimation, the odds by using D -lactate measurement were as small as 
1.059 for grade II, 1.155 for grade III, and 1.088 for grade IV, although statistically 
significant. This reviewer thinks the results suggested that D -lactate measurem ent was 
clinically inapplicable to AGI grade estimation.  
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which contro ls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of compe ting interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially  from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If you r reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
   
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/ licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Association between acute gastrointestinal injury and biomarkers of intestinal barrier  
function in critically ill patients  
 
Version: 0 Date: 14 Dec 2016  
 
Reviewer: Tatsuo Kanda  
 
Reviewer's report:  
 
GENERAL  
 
This is a prospective study that explored the association between biomarkers and acute 
gastrointestinal injury (AGI) in critically ill patients. By analyzing 90 patients in the intensive 
care unit (ICU) of their i nstitution, the authors concluded that D -lactate was a better biomarker 
for AGI than other blood markers. Although the present study included many analyses, the study 
design was obscure. Furthermore, the authors did not show any data indicating how D -lacta te 
measurement should be used in practice and to what extent the AGI diagnosis would be 
improved in quality by using this biomarker. For these reasons, this reviewer thinks the present 
manuscript is not worth publishing in BMC Gastroenterology.  
 
 
 
 
SPECIFIC  
 
1. This reviewer could not find human I -FABP ELISA in BioRad's product line -up. The 
authors should show the code in the catalogue.  
 
 
 
2. The D -lactate cutoff level should be clearly shown.  
 
 
 
3. In the AGI grade estimation, the odds by using D -lactate measurement were as small as 
1.059 for grade II, 1.155 for grade III, and 1.088 for grade IV, although statistically 
significant. This reviewer thinks the results suggested that D -lactate measurem ent was 
clinically inapplicable to AGI grade estimation.  
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which contro ls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of compe ting interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially  from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If you r reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
   
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/ licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant