Reviewer ’s report  
 
Title:  Evaluation of scoring systems without endoscopic findings for predicting outcomes in 
patients with upper gastrointestinal bleeding  
 
Version: 0 Date: 04 Sep 2017 
 
Reviewer:  Kuei -Chuan  Lee 
 
Reviewer’s report:  
 
In this study, IG Kuo  et al retrospectively reviewed 590 patients with upper gastrointestinal 
bleeding (UGIB). They aimed to compare the three scoring systems which were used to evaluate 
the severity and outcomes of patients with UGIB before endoscopy performed. They also 
investigated the potential cutoff scores to predict the need of interventions and 30 -day mortality 
in applicable scoring systems. This study gives us some good concepts in evaluation of UGIB 
patient generally. I think the study has some values in practical car e of UGIB patients.  
 
Major comments  
 
1. There were many diseases to cause UGIB, such as variceal bleeding, peptic ulcer 
disease, malignancy etc…, and different medication or interventions may be 
performed to treat different causes to UGIB. This study includes  all UGIB conditions, 
as a result, there may be lots of confounding factors. I suggest analyze outcomes of 
subgroups (variceal bleeding vs. non -variceal bleeding, vs. malignancy) by the 
scoring systems.  
 
2. As mention to UGIB prognosis, we do care about rebl eeding rate besides mortality. 
Do you have the rebleeding rate of the study patients after medication or intervention 
therapy? Were there any relationships between the scores and rebleeding rate?  
 
3. Minor  
 
1. Page 2, line 18, "…for the need for interventions was (70.71 % sensitivity, …."  
 
Should be "…for the need for interventions was 9 (70.71% sensitivity,…"  
 
2. Page 6, " Study population "  
 
Since the study were carried out at a teaching center, did you exclude t he patients who were 
referred from other primary hospitals? Because these referred patients may have already received 
interventions before.  
 
3. Page 7, line 2, " The proton pump inhibitor…"  
 
Nowadays we all know that high dose PPI may downgrade the severity o f Forrest classification 
when endoscopy is performed. Do you record the patients' proportion of receiving high dose 
PPI?  
 
4. Page 25, "Table 2"  
 
Since the patients were reviewed between 2007 -2016, were there patients who received 
clopidogrel or NOAC (novel or al anticoagulant)? Because you only record Aspirin and Warfarin 
in your table.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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:  
 
Needs some language corrections before being published  
 
Declaration of competing 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 your reply is yes to any, please give details below.  
 
nil 
 
I agree to th e 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:  Evaluation of scoring systems without endoscopic findings for predicting outcomes in 
patients with upper gastrointestinal bleeding  
 
Version: 0 Date: 04 Sep 2017 
 
Reviewer:  Kuei -Chuan  Lee 
 
Reviewer’s report:  
 
In this study, IG Kuo  et al retrospectively reviewed 590 patients with upper gastrointestinal 
bleeding (UGIB). They aimed to compare the three scoring systems which were used to evaluate 
the severity and outcomes of patients with UGIB before endoscopy performed. They also 
investigated the potential cutoff scores to predict the need of interventions and 30 -day mortality 
in applicable scoring systems. This study gives us some good concepts in evaluation of UGIB 
patient generally. I think the study has some values in practical car e of UGIB patients.  
 
Major comments  
 
1. There were many diseases to cause UGIB, such as variceal bleeding, peptic ulcer 
disease, malignancy etc…, and different medication or interventions may be 
performed to treat different causes to UGIB. This study includes  all UGIB conditions, 
as a result, there may be lots of confounding factors. I suggest analyze outcomes of 
subgroups (variceal bleeding vs. non -variceal bleeding, vs. malignancy) by the 
scoring systems.  
 
2. As mention to UGIB prognosis, we do care about rebl eeding rate besides mortality. 
Do you have the rebleeding rate of the study patients after medication or intervention 
therapy? Were there any relationships between the scores and rebleeding rate?  
 
3. Minor  
 
1. Page 2, line 18, "…for the need for interventions was (70.71 % sensitivity, …."  
 
Should be "…for the need for interventions was 9 (70.71% sensitivity,…"  
 
2. Page 6, " Study population "  
 
Since the study were carried out at a teaching center, did you exclude t he patients who were 
referred from other primary hospitals? Because these referred patients may have already received 
interventions before.  
 
3. Page 7, line 2, " The proton pump inhibitor…"  
 
Nowadays we all know that high dose PPI may downgrade the severity o f Forrest classification 
when endoscopy is performed. Do you record the patients' proportion of receiving high dose 
PPI?  
 
4. Page 25, "Table 2"  
 
Since the patients were reviewed between 2007 -2016, were there patients who received 
clopidogrel or NOAC (novel or al anticoagulant)? Because you only record Aspirin and Warfarin 
in your table.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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:  
 
Needs some language corrections before being published  
 
Declaration of competing 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 your reply is yes to any, please give details below.  
 
nil 
 
I agree to th e 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:  Evaluation of scoring systems without endoscopic findings for predicting outcomes in 
patients with upper gastrointestinal bleeding  
 
Version: 0 Date: 04 Sep 2017 
 
Reviewer:  Kuei -Chuan  Lee 
 
Reviewer’s report:  
 
In this study, IG Kuo  et al retrospectively reviewed 590 patients with upper gastrointestinal 
bleeding (UGIB). They aimed to compare the three scoring systems which were used to evaluate 
the severity and outcomes of patients with UGIB before endoscopy performed. They also 
investigated the potential cutoff scores to predict the need of interventions and 30 -day mortality 
in applicable scoring systems. This study gives us some good concepts in evaluation of UGIB 
patient generally. I think the study has some values in practical car e of UGIB patients.  
 
Major comments  
 
1. There were many diseases to cause UGIB, such as variceal bleeding, peptic ulcer 
disease, malignancy etc…, and different medication or interventions may be 
performed to treat different causes to UGIB. This study includes  all UGIB conditions, 
as a result, there may be lots of confounding factors. I suggest analyze outcomes of 
subgroups (variceal bleeding vs. non -variceal bleeding, vs. malignancy) by the 
scoring systems.  
 
2. As mention to UGIB prognosis, we do care about rebl eeding rate besides mortality. 
Do you have the rebleeding rate of the study patients after medication or intervention 
therapy? Were there any relationships between the scores and rebleeding rate?  
 
3. Minor  
 
1. Page 2, line 18, "…for the need for interventions was (70.71 % sensitivity, …."  
 
Should be "…for the need for interventions was 9 (70.71% sensitivity,…"  
 
2. Page 6, " Study population "  
 
Since the study were carried out at a teaching center, did you exclude t he patients who were 
referred from other primary hospitals? Because these referred patients may have already received 
interventions before.  
 
3. Page 7, line 2, " The proton pump inhibitor…"  
 
Nowadays we all know that high dose PPI may downgrade the severity o f Forrest classification 
when endoscopy is performed. Do you record the patients' proportion of receiving high dose 
PPI?  
 
4. Page 25, "Table 2"  
 
Since the patients were reviewed between 2007 -2016, were there patients who received 
clopidogrel or NOAC (novel or al anticoagulant)? Because you only record Aspirin and Warfarin 
in your table.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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:  
 
Needs some language corrections before being published  
 
Declaration of competing 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 your reply is yes to any, please give details below.  
 
nil 
 
I agree to th e 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