Reviewer's report 
 Hepatopulmonary syndrome in patients with chronic liver disease: role of pulse oximetry Title: 
 1  9 March 2006 Version: Date: 
 pilar taura Reviewer: 
Reviewer's report: 
General 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
General comments 
The article submited by Delieber et al entitle "Hepatopulmonary Syndrome....role of pulse oximetry" is focussed on evaluating the use of pulse oximetry to identify patients with HPS. The authors concluded that this non-invasive test is a useful screening test for HPS which has an incidence of 
about 5%. 
- The diagnostic criteria for HPS have not been defined in "Methods". It is well known that there is enough evidence to clarify the diagnostic criteria for HPS. Recently, as a result of a Task Force, a group of experts in HPS defined the more adequate criteria (Eur J Resp Dis) 
- One of clearest criteria for HPS is the evidence, by means of echocardiography or lug perfusion 
scaning, of intrapulmonary vascular dilatation. In order to evaluate the utility of a test to diagnose an entity, you need to confirm or negate this entity by means the gold standard test. Consequently, it seems to be obvious that, in all patients echocardiography or lung perfusion scaning sould have 
been done. 
- Although the aim of the study is very interesting and, probably, pulse oximetry is a uselful scrining test for moderate-to-severe HPS, the incidence of mild or fustres forms could be underestimated. In Results: 
- There is some redundant and superfluous information in the first and second paragraph that are 
summarized in a table and can be omitted. - The information included in paragrapf 4 and 5 would be much clear if shown on a table - It is difficult to arrive to a conclusion that there is a good correlation between shunt volum and pO2 
or Sao when the statistical study was based on only four patients. Nevertheless it is indisputable 
that the results are statistically correct. Summary 
This study has been well done if the objective was to quickly identify in a simple manner severe HPS 
in patients with chronic liver disease or non-cirrhotic portal hypertension, however it not useful to 
identify "the incidence" of HPS. It could have suggested ways to identify mild or fustres forms (clinical data or functional respiratory study) in order to increase the diagnostic percentage. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interest 
Reviewer's report 
 Hepatopulmonary syndrome in patients with chronic liver disease: role of pulse oximetry Title: 
 1  9 March 2006 Version: Date: 
 pilar taura Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
General comments 
The article submited by Delieber et al entitle "Hepatopulmonary Syndrome....role of pulse oximetry" is focussed on evaluating the use of pulse oximetry to identify patients with HPS. The authors concluded that this non-invasive test is a useful screening test for HPS which has an incidence of 
about 5%. 
- The diagnostic criteria for HPS have not been defined in "Methods". It is well known that there is enough evidence to clarify the diagnostic criteria for HPS. Recently, as a result of a Task Force, a group of experts in HPS defined the more adequate criteria (Eur J Resp Dis) 
- One of clearest criteria for HPS is the evidence, by means of echocardiography or lug perfusion 
scaning, of intrapulmonary vascular dilatation. In order to evaluate the utility of a test to diagnose an entity, you need to confirm or negate this entity by means the gold standard test. Consequently, it seems to be obvious that, in all patients echocardiography or lung perfusion scaning sould have 
been done. 
- Although the aim of the study is very interesting and, probably, pulse oximetry is a uselful scrining test for moderate-to-severe HPS, the incidence of mild or fustres forms could be underestimated. In Results: 
- There is some redundant and superfluous information in the first and second paragraph that are 
summarized in a table and can be omitted. - The information included in paragrapf 4 and 5 would be much clear if shown on a table - It is difficult to arrive to a conclusion that there is a good correlation between shunt volum and pO2 
or Sao when the statistical study was based on only four patients. Nevertheless it is indisputable 
that the results are statistically correct. Summary 
This study has been well done if the objective was to quickly identify in a simple manner severe HPS 
in patients with chronic liver disease or non-cirrhotic portal hypertension, however it not useful to 
identify "the incidence" of HPS. It could have suggested ways to identify mild or fustres forms (clinical data or functional respiratory study) in order to increase the diagnostic percentage. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interest 
Please review this paper.
user
Reviewer's report 
 Hepatopulmonary syndrome in patients with chronic liver disease: role of pulse oximetry Title: 
 1  9 March 2006 Version: Date: 
 pilar taura Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
General comments 
The article submited by Delieber et al entitle "Hepatopulmonary Syndrome....role of pulse oximetry" is focussed on evaluating the use of pulse oximetry to identify patients with HPS. The authors concluded that this non-invasive test is a useful screening test for HPS which has an incidence of 
about 5%. 
- The diagnostic criteria for HPS have not been defined in "Methods". It is well known that there is enough evidence to clarify the diagnostic criteria for HPS. Recently, as a result of a Task Force, a group of experts in HPS defined the more adequate criteria (Eur J Resp Dis) 
- One of clearest criteria for HPS is the evidence, by means of echocardiography or lug perfusion 
scaning, of intrapulmonary vascular dilatation. In order to evaluate the utility of a test to diagnose an entity, you need to confirm or negate this entity by means the gold standard test. Consequently, it seems to be obvious that, in all patients echocardiography or lung perfusion scaning sould have 
been done. 
- Although the aim of the study is very interesting and, probably, pulse oximetry is a uselful scrining test for moderate-to-severe HPS, the incidence of mild or fustres forms could be underestimated. In Results: 
- There is some redundant and superfluous information in the first and second paragraph that are 
summarized in a table and can be omitted. - The information included in paragrapf 4 and 5 would be much clear if shown on a table - It is difficult to arrive to a conclusion that there is a good correlation between shunt volum and pO2 
or Sao when the statistical study was based on only four patients. Nevertheless it is indisputable 
that the results are statistically correct. Summary 
This study has been well done if the objective was to quickly identify in a simple manner severe HPS 
in patients with chronic liver disease or non-cirrhotic portal hypertension, however it not useful to 
identify "the incidence" of HPS. It could have suggested ways to identify mild or fustres forms (clinical data or functional respiratory study) in order to increase the diagnostic percentage. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interest 
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