Reviewer ’s report  
 
Title: Signif icantly different clinical features between hypertriglyceridemia and biliary acute 
pancreatitis: A Retrospective Study of 730 Patients from A Tertiary  
 
Version: 0 Date: 09 Nov 2017  
 
Reviewer: Eisuke Iwasaki  
 
Reviewer's report:  
 
Authors showed that HTG -AP patients suffered more severe systemic inflammation reaction, 
while BAP patient s had a greater severity of infected complications. Although aim of this study 
is interesting, authors should concern below points.  
 
Major comments  
1. The authors described that HTG -AP patients suffered more severe systemic inflammation 
reaction. However, HTG -AP patients had higher BMI than BAP patients. All systemic 
complication may be caused by high BMI. The authors should adjust this confound factor by 
multivariable analysis for all systemic complication.   
 
2. The authors exclude older than 75 years old  age and pregnancy patients. However it was not 
reasonable to compare HTG -AP patients and BAP patients. The author should include these 
patients.  
 
3. The authors described that "TG -mediated lipotoxicity may be an attractive target for novel 
interventions for severe AP" in discussion section. To confirm this hypothesis, the author 
had better divided into three groups according to the value of TG level: group A: < Xmg/dl 
(less than the first quartile), group B: X -Ymg/dl (between the first and third quartile s), and 
group C: >Ymg/dl (more than the third quartile). After comparing characteristics among 
three groups, Cochran -Armitage trend test would be performed for systemic complication. 
(JAMA 2007; 298: 309 -316)   
 
4. The authors described that "While the inc idence of hypertriglyceridemia acute pancreatitis 
(HTG -AP) was much higher in Asia and increased year by year according to recent reports 
[5-10]". However Japan which is one of Asia had low incidence of HTG -AP. Recent 
multicenter cohort study in Japan show ed only 2.19% (Pancreas. 2017;46(4):510 -7.) The 
author had better to cite and change the word "in Asia" to "in China". Moreover, the author 
described that Gallstones and hypertriglyceridemia (HTG) are among the most common 
causes of acute pancreatitis (AP)  in abstract. Most common causes of AP are Gallstones and 
Alcohol in the world.  
 
5. Their article result including the first three etiologies were gallstones (50%), 
hypertriglyceridemia (30%), and alcohol (5%) were written in introduction section. The 
author should remove these results from introduction.  
 
Minor comments  
6. In revised Atlanta classification, the severity was divided into mild acute pancreatitis, 
moderately severe acute pancreatitis and severe acute pancreatitis. The description in their 
article was wrong. In figure 2, the author had better rearrange by severity( mild, moderate 
severe and severe)  
 
7. According to demographic data and baseline, the number of main text and that of table 1 are 
different. The number of Male also is also wrong.  
 
8. There is no description about table 2 and table 5 in main text.  
 
9. In data collection section the author had better avoid "etc".  
 
10. The author had better use International System of Units in main text and table.  
Are the method s 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 stat istical 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:  
 
Acceptabl e 
 
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 ga in 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 f uture?  
 
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.  
 
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 ac cepted 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://creativecommo ns.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: Signif icantly different clinical features between hypertriglyceridemia and biliary acute 
pancreatitis: A Retrospective Study of 730 Patients from A Tertiary  
 
Version: 0 Date: 09 Nov 2017  
 
Reviewer: Eisuke Iwasaki  
 
Reviewer's report:  
 
Authors showed that HTG -AP patients suffered more severe systemic inflammation reaction, 
while BAP patient s had a greater severity of infected complications. Although aim of this study 
is interesting, authors should concern below points.  
 
Major comments  
1. The authors described that HTG -AP patients suffered more severe systemic inflammation 
reaction. However, HTG -AP patients had higher BMI than BAP patients. All systemic 
complication may be caused by high BMI. The authors should adjust this confound factor by 
multivariable analysis for all systemic complication.   
 
2. The authors exclude older than 75 years old  age and pregnancy patients. However it was not 
reasonable to compare HTG -AP patients and BAP patients. The author should include these 
patients.  
 
3. The authors described that "TG -mediated lipotoxicity may be an attractive target for novel 
interventions for severe AP" in discussion section. To confirm this hypothesis, the author 
had better divided into three groups according to the value of TG level: group A: < Xmg/dl 
(less than the first quartile), group B: X -Ymg/dl (between the first and third quartile s), and 
group C: >Ymg/dl (more than the third quartile). After comparing characteristics among 
three groups, Cochran -Armitage trend test would be performed for systemic complication. 
(JAMA 2007; 298: 309 -316)   
 
4. The authors described that "While the inc idence of hypertriglyceridemia acute pancreatitis 
(HTG -AP) was much higher in Asia and increased year by year according to recent reports 
[5-10]". However Japan which is one of Asia had low incidence of HTG -AP. Recent 
multicenter cohort study in Japan show ed only 2.19% (Pancreas. 2017;46(4):510 -7.) The 
author had better to cite and change the word "in Asia" to "in China". Moreover, the author 
described that Gallstones and hypertriglyceridemia (HTG) are among the most common 
causes of acute pancreatitis (AP)  in abstract. Most common causes of AP are Gallstones and 
Alcohol in the world.  
 
5. Their article result including the first three etiologies were gallstones (50%), 
hypertriglyceridemia (30%), and alcohol (5%) were written in introduction section. The 
author should remove these results from introduction.  
 
Minor comments  
6. In revised Atlanta classification, the severity was divided into mild acute pancreatitis, 
moderately severe acute pancreatitis and severe acute pancreatitis. The description in their 
article was wrong. In figure 2, the author had better rearrange by severity( mild, moderate 
severe and severe)  
 
7. According to demographic data and baseline, the number of main text and that of table 1 are 
different. The number of Male also is also wrong.  
 
8. There is no description about table 2 and table 5 in main text.  
 
9. In data collection section the author had better avoid "etc".  
 
10. The author had better use International System of Units in main text and table.  
Are the method s 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 stat istical 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:  
 
Acceptabl e 
 
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 ga in 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 f uture?  
 
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.  
 
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 ac cepted 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://creativecommo ns.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: Signif icantly different clinical features between hypertriglyceridemia and biliary acute 
pancreatitis: A Retrospective Study of 730 Patients from A Tertiary  
 
Version: 0 Date: 09 Nov 2017  
 
Reviewer: Eisuke Iwasaki  
 
Reviewer's report:  
 
Authors showed that HTG -AP patients suffered more severe systemic inflammation reaction, 
while BAP patient s had a greater severity of infected complications. Although aim of this study 
is interesting, authors should concern below points.  
 
Major comments  
1. The authors described that HTG -AP patients suffered more severe systemic inflammation 
reaction. However, HTG -AP patients had higher BMI than BAP patients. All systemic 
complication may be caused by high BMI. The authors should adjust this confound factor by 
multivariable analysis for all systemic complication.   
 
2. The authors exclude older than 75 years old  age and pregnancy patients. However it was not 
reasonable to compare HTG -AP patients and BAP patients. The author should include these 
patients.  
 
3. The authors described that "TG -mediated lipotoxicity may be an attractive target for novel 
interventions for severe AP" in discussion section. To confirm this hypothesis, the author 
had better divided into three groups according to the value of TG level: group A: < Xmg/dl 
(less than the first quartile), group B: X -Ymg/dl (between the first and third quartile s), and 
group C: >Ymg/dl (more than the third quartile). After comparing characteristics among 
three groups, Cochran -Armitage trend test would be performed for systemic complication. 
(JAMA 2007; 298: 309 -316)   
 
4. The authors described that "While the inc idence of hypertriglyceridemia acute pancreatitis 
(HTG -AP) was much higher in Asia and increased year by year according to recent reports 
[5-10]". However Japan which is one of Asia had low incidence of HTG -AP. Recent 
multicenter cohort study in Japan show ed only 2.19% (Pancreas. 2017;46(4):510 -7.) The 
author had better to cite and change the word "in Asia" to "in China". Moreover, the author 
described that Gallstones and hypertriglyceridemia (HTG) are among the most common 
causes of acute pancreatitis (AP)  in abstract. Most common causes of AP are Gallstones and 
Alcohol in the world.  
 
5. Their article result including the first three etiologies were gallstones (50%), 
hypertriglyceridemia (30%), and alcohol (5%) were written in introduction section. The 
author should remove these results from introduction.  
 
Minor comments  
6. In revised Atlanta classification, the severity was divided into mild acute pancreatitis, 
moderately severe acute pancreatitis and severe acute pancreatitis. The description in their 
article was wrong. In figure 2, the author had better rearrange by severity( mild, moderate 
severe and severe)  
 
7. According to demographic data and baseline, the number of main text and that of table 1 are 
different. The number of Male also is also wrong.  
 
8. There is no description about table 2 and table 5 in main text.  
 
9. In data collection section the author had better avoid "etc".  
 
10. The author had better use International System of Units in main text and table.  
Are the method s 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 stat istical 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:  
 
Acceptabl e 
 
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 ga in 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 f uture?  
 
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.  
 
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 ac cepted 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://creativecommo ns.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