Reviewer ’s report  
 
Title: The clinical value of adipokines in predicting the severity and outcome of acute 
pancreatitis  
 
 
Version: 0 Date: 28 May 2016  
 
 
Reviewer: Mihailo  Bezmarevic  
 
Reviewer's report:  
 
General comment  
This is prospective  observational cohort study which compare a serum values of adipokines and 
other cytokines and CRP in AP patients and healthy subjects. The study is well designed with 
satisfactory number of patients included in study, there are a lot of data included and 
comparisons made. However, a number of data are unnecessary to compare due to lot of studies 
in previous years. This includes prognostic scores and volume of pancreatic necrosis. It is 
enough to compare SOFA and modified CTSI score. Also, on my opinion, if  authors used 
revision of Atlanta classification, they should use and compare only SOFA and modified 
Marshall score between 4 groups of patients. Pancreatic necrosis and volume of necrosis, BISAP 
and HAPS scores  are data which are unnecessary.  
As reporte d previously in several studies, adipokines are important and they have a predictive 
role in course in AP only in obese population. It should be very interesting and possible scientific 
good value if authors perform a division of AP patients according BMI.  After patients 
categorization into maybe 3 groups (normal BMI, obese and very obese) it should be possible to 
made a comparisons between those groups in relation to the disease severity, adipokines and IL -
6 and CRP. After that, the authors could calculate  a cut -off value for adipokines and IL -6 for 
prediction severe form of AP in patients with high BMI. Also, it can be calculate a cut -off value 
for BMI that correlate with high levels of adipokines. This kind of investigation could help in 
routine clinical practice in assessment of high risk (high BMI) patients who have a need for 
adipokines analysis and prediction of severe form of AP. This is worth to discuss!  
The English must be corrected by native English speaker.  
 
 
Specific comment  
Abstract: Background is too long - there is significant benefit in treatment of AP patients - step 
up approach, but there is no benefit for usage of prophylactic antibiotic therapy!!! Early 
classification of AP severity is not remain problematic!!! There is clearly defined cri teria for 
early assessment of AP severity in routine clinical practice! Usage of adiponektins and other 
proinflammatory mediators have only scientific value for now. Maybe in the future.   
There is no need for mentioning revised Atlanta classification seve ral times. The patients were 
categorized according revised Atlanta in 3 groups.  
There is no need for mentioning that CT was performed in patients in abstract. Disease severity 
probably was assessed retrospectively according Atlanta classification based on well defined 
criteria (persistent OF)! This is the main issue for the assessment of AP severity. It must be 
mentioned and reported in abstract and in the methods and results also.  
Methods: If authors used revision Atlanta classification for stratifying patients in 3 groups based 
on the severity, they need to used organ failure as main determinant for disease severity 
assessment! CT is used only for evaluation of morphological change s and indication for 
interventional treatment.  
Results: Well known and supporting facts that affect on decision for intervention, such as 
pancreatic and peripancreatic necrosis in SAP, should not be a issue for comparison neither 
discussion in this paper. The title of this investigation is rule of adipokines in assessment of 
disease severity and outcome.  
The authors should be focused only on this issue, regardless they have a lot of data which are not 
so relevant and are redundant.  
Tables: lot of unnecess ary data.  
 
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 supporte d 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 spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language c orrections before being published  
 
Declaration of competing interests  
Please comp lete 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 t his 
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 apply ing 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 y es to any, please give details below.  
 
I declare that I have no competing interests' below  
 
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 th at 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: The clinical value of adipokines in predicting the severity and outcome of acute 
pancreatitis  
 
 
Version: 0 Date: 28 May 2016  
 
 
Reviewer: Mihailo  Bezmarevic  
 
Reviewer's report:  
 
General comment  
This is prospective  observational cohort study which compare a serum values of adipokines and 
other cytokines and CRP in AP patients and healthy subjects. The study is well designed with 
satisfactory number of patients included in study, there are a lot of data included and 
comparisons made. However, a number of data are unnecessary to compare due to lot of studies 
in previous years. This includes prognostic scores and volume of pancreatic necrosis. It is 
enough to compare SOFA and modified CTSI score. Also, on my opinion, if  authors used 
revision of Atlanta classification, they should use and compare only SOFA and modified 
Marshall score between 4 groups of patients. Pancreatic necrosis and volume of necrosis, BISAP 
and HAPS scores  are data which are unnecessary.  
As reporte d previously in several studies, adipokines are important and they have a predictive 
role in course in AP only in obese population. It should be very interesting and possible scientific 
good value if authors perform a division of AP patients according BMI.  After patients 
categorization into maybe 3 groups (normal BMI, obese and very obese) it should be possible to 
made a comparisons between those groups in relation to the disease severity, adipokines and IL -
6 and CRP. After that, the authors could calculate  a cut -off value for adipokines and IL -6 for 
prediction severe form of AP in patients with high BMI. Also, it can be calculate a cut -off value 
for BMI that correlate with high levels of adipokines. This kind of investigation could help in 
routine clinical practice in assessment of high risk (high BMI) patients who have a need for 
adipokines analysis and prediction of severe form of AP. This is worth to discuss!  
The English must be corrected by native English speaker.  
 
 
Specific comment  
Abstract: Background is too long - there is significant benefit in treatment of AP patients - step 
up approach, but there is no benefit for usage of prophylactic antibiotic therapy!!! Early 
classification of AP severity is not remain problematic!!! There is clearly defined cri teria for 
early assessment of AP severity in routine clinical practice! Usage of adiponektins and other 
proinflammatory mediators have only scientific value for now. Maybe in the future.   
There is no need for mentioning revised Atlanta classification seve ral times. The patients were 
categorized according revised Atlanta in 3 groups.  
There is no need for mentioning that CT was performed in patients in abstract. Disease severity 
probably was assessed retrospectively according Atlanta classification based on well defined 
criteria (persistent OF)! This is the main issue for the assessment of AP severity. It must be 
mentioned and reported in abstract and in the methods and results also.  
Methods: If authors used revision Atlanta classification for stratifying patients in 3 groups based 
on the severity, they need to used organ failure as main determinant for disease severity 
assessment! CT is used only for evaluation of morphological change s and indication for 
interventional treatment.  
Results: Well known and supporting facts that affect on decision for intervention, such as 
pancreatic and peripancreatic necrosis in SAP, should not be a issue for comparison neither 
discussion in this paper. The title of this investigation is rule of adipokines in assessment of 
disease severity and outcome.  
The authors should be focused only on this issue, regardless they have a lot of data which are not 
so relevant and are redundant.  
Tables: lot of unnecess ary data.  
 
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 supporte d 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 spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language c orrections before being published  
 
Declaration of competing interests  
Please comp lete 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 t his 
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 apply ing 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 y es to any, please give details below.  
 
I declare that I have no competing interests' below  
 
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 th at 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: The clinical value of adipokines in predicting the severity and outcome of acute 
pancreatitis  
 
 
Version: 0 Date: 28 May 2016  
 
 
Reviewer: Mihailo  Bezmarevic  
 
Reviewer's report:  
 
General comment  
This is prospective  observational cohort study which compare a serum values of adipokines and 
other cytokines and CRP in AP patients and healthy subjects. The study is well designed with 
satisfactory number of patients included in study, there are a lot of data included and 
comparisons made. However, a number of data are unnecessary to compare due to lot of studies 
in previous years. This includes prognostic scores and volume of pancreatic necrosis. It is 
enough to compare SOFA and modified CTSI score. Also, on my opinion, if  authors used 
revision of Atlanta classification, they should use and compare only SOFA and modified 
Marshall score between 4 groups of patients. Pancreatic necrosis and volume of necrosis, BISAP 
and HAPS scores  are data which are unnecessary.  
As reporte d previously in several studies, adipokines are important and they have a predictive 
role in course in AP only in obese population. It should be very interesting and possible scientific 
good value if authors perform a division of AP patients according BMI.  After patients 
categorization into maybe 3 groups (normal BMI, obese and very obese) it should be possible to 
made a comparisons between those groups in relation to the disease severity, adipokines and IL -
6 and CRP. After that, the authors could calculate  a cut -off value for adipokines and IL -6 for 
prediction severe form of AP in patients with high BMI. Also, it can be calculate a cut -off value 
for BMI that correlate with high levels of adipokines. This kind of investigation could help in 
routine clinical practice in assessment of high risk (high BMI) patients who have a need for 
adipokines analysis and prediction of severe form of AP. This is worth to discuss!  
The English must be corrected by native English speaker.  
 
 
Specific comment  
Abstract: Background is too long - there is significant benefit in treatment of AP patients - step 
up approach, but there is no benefit for usage of prophylactic antibiotic therapy!!! Early 
classification of AP severity is not remain problematic!!! There is clearly defined cri teria for 
early assessment of AP severity in routine clinical practice! Usage of adiponektins and other 
proinflammatory mediators have only scientific value for now. Maybe in the future.   
There is no need for mentioning revised Atlanta classification seve ral times. The patients were 
categorized according revised Atlanta in 3 groups.  
There is no need for mentioning that CT was performed in patients in abstract. Disease severity 
probably was assessed retrospectively according Atlanta classification based on well defined 
criteria (persistent OF)! This is the main issue for the assessment of AP severity. It must be 
mentioned and reported in abstract and in the methods and results also.  
Methods: If authors used revision Atlanta classification for stratifying patients in 3 groups based 
on the severity, they need to used organ failure as main determinant for disease severity 
assessment! CT is used only for evaluation of morphological change s and indication for 
interventional treatment.  
Results: Well known and supporting facts that affect on decision for intervention, such as 
pancreatic and peripancreatic necrosis in SAP, should not be a issue for comparison neither 
discussion in this paper. The title of this investigation is rule of adipokines in assessment of 
disease severity and outcome.  
The authors should be focused only on this issue, regardless they have a lot of data which are not 
so relevant and are redundant.  
Tables: lot of unnecess ary data.  
 
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 supporte d 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 spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language c orrections before being published  
 
Declaration of competing interests  
Please comp lete 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 t his 
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 apply ing 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 y es to any, please give details below.  
 
I declare that I have no competing interests' below  
 
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 th at 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