Title: Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Septic Patients with Liver
Cirrhosis: A Cohort Study
Version: 0 Date: 29 Apr 2025
Reviewer's report:
Reviewer Comments:
This study investigates the prognostic value of the neutrophil-to-lymphocyte ratio (NLR)
in patients with liver cirrhosis and sepsis, addressing a clinically significant topic. The
methodology is well-structured, leveraging the MIMIC-IV database for reliable data sourcing,
and the statistical analysis is rigorous. The findings suggest that NLR serves as an independent
risk factor for in-hospital mortality in this high-risk population, with predictive performance
surpassing SOFA scores. However, certain methodological details and discussion depth require
refinement to enhance scientific rigor and generalizability.
Specific Comments:
1. The process of identifying cirrhosis patients from the sepsis cohort (n=34,677) using ICD
codes is described but lacks technical specifics. Please clarify: How the septic patients with
cirrhosis were identified (e.g., SQL INTERSECT operations or patient ID matching).
2. The exclusion of patients with missing marital status (n=233) lacks justification. Explain
the rationale for excluding patients with missing marital status. If marital status is unrelated to
prognosis, this exclusion may introduce selection bias.
3. Key indicators of cirrhosis severity (e.g., Child-Pugh or MELD scores) were not adjusted
for in model #. Since disease stage critically impacts outcomes, their omission risks residual
confounding.
4. The manuscript states 1,372 total included patients, how to explain  1,372 survivors and 101
non-survivors.
5. Baseline Characteristics (Table 1): Units are inconsistently labeled (e.g., ALT as "U/l" vs.
AST as "U").
6. How to explain the dead group has significantly lower CHF and Diabetes mellitus incidence
than the alive group? Why not take a multiple logestic regression including all the significant
univariate variables?
7.  “Activated partial thromboplastin time” is abbreviated as “APPT” but is conventionally
“APTT.”
Title: Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Septic Patients with Liver
Cirrhosis: A Cohort Study
Version: 0 Date: 29 Apr 2025
Reviewer's report:
Reviewer Comments:
This study investigates the prognostic value of the neutrophil-to-lymphocyte ratio (NLR)
in patients with liver cirrhosis and sepsis, addressing a clinically significant topic. The
methodology is well-structured, leveraging the MIMIC-IV database for reliable data sourcing,
and the statistical analysis is rigorous. The findings suggest that NLR serves as an independent
risk factor for in-hospital mortality in this high-risk population, with predictive performance
surpassing SOFA scores. However, certain methodological details and discussion depth require
refinement to enhance scientific rigor and generalizability.
Specific Comments:
1. The process of identifying cirrhosis patients from the sepsis cohort (n=34,677) using ICD
codes is described but lacks technical specifics. Please clarify: How the septic patients with
cirrhosis were identified (e.g., SQL INTERSECT operations or patient ID matching).
2. The exclusion of patients with missing marital status (n=233) lacks justification. Explain
the rationale for excluding patients with missing marital status. If marital status is unrelated to
prognosis, this exclusion may introduce selection bias.
3. Key indicators of cirrhosis severity (e.g., Child-Pugh or MELD scores) were not adjusted
for in model #. Since disease stage critically impacts outcomes, their omission risks residual
confounding.
4. The manuscript states 1,372 total included patients, how to explain  1,372 survivors and 101
non-survivors.
5. Baseline Characteristics (Table 1): Units are inconsistently labeled (e.g., ALT as "U/l" vs.
AST as "U").
6. How to explain the dead group has significantly lower CHF and Diabetes mellitus incidence
than the alive group? Why not take a multiple logestic regression including all the significant
univariate variables?
7.  “Activated partial thromboplastin time” is abbreviated as “APPT” but is conventionally
“APTT.”
Please review this paper.
user
Title: Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Septic Patients with Liver
Cirrhosis: A Cohort Study
Version: 0 Date: 29 Apr 2025
Reviewer's report:
Reviewer Comments:
This study investigates the prognostic value of the neutrophil-to-lymphocyte ratio (NLR)
in patients with liver cirrhosis and sepsis, addressing a clinically significant topic. The
methodology is well-structured, leveraging the MIMIC-IV database for reliable data sourcing,
and the statistical analysis is rigorous. The findings suggest that NLR serves as an independent
risk factor for in-hospital mortality in this high-risk population, with predictive performance
surpassing SOFA scores. However, certain methodological details and discussion depth require
refinement to enhance scientific rigor and generalizability.
Specific Comments:
1. The process of identifying cirrhosis patients from the sepsis cohort (n=34,677) using ICD
codes is described but lacks technical specifics. Please clarify: How the septic patients with
cirrhosis were identified (e.g., SQL INTERSECT operations or patient ID matching).
2. The exclusion of patients with missing marital status (n=233) lacks justification. Explain
the rationale for excluding patients with missing marital status. If marital status is unrelated to
prognosis, this exclusion may introduce selection bias.
3. Key indicators of cirrhosis severity (e.g., Child-Pugh or MELD scores) were not adjusted
for in model #. Since disease stage critically impacts outcomes, their omission risks residual
confounding.
4. The manuscript states 1,372 total included patients, how to explain  1,372 survivors and 101
non-survivors.
5. Baseline Characteristics (Table 1): Units are inconsistently labeled (e.g., ALT as "U/l" vs.
AST as "U").
6. How to explain the dead group has significantly lower CHF and Diabetes mellitus incidence
than the alive group? Why not take a multiple logestic regression including all the significant
univariate variables?
7.  “Activated partial thromboplastin time” is abbreviated as “APPT” but is conventionally
“APTT.”
assistant