Reviewer's report
Title:Predictors of Esophageal Varices in Patients With HBV-related Cirrhosis: A
retrospective study
Version: 1Date:8 September 2008
Reviewer: Roberto de Franchis
Reviewer's report:
The topic of predicting the presence of esophageal varices in patients with
cirrhosis before doing endoscopy is an important one, because, if an adequate
method could be developed for this task, this could greatly decrease the
workload of endoscopy units.
The paper by Hong et al. is yet another attempt to tackle this goal, and suffers
from the same limitations of several previous studies.
The Authors should be commended for a thorough statistical evaluation of the
performance of their model; however, some points need discussion:
Major compulsory revisions
1. The population is largely composed of patients with decompensated cirrhosis,
and only partially reflects the population in which an index to predict the presence
of varices would be mostly applied in clinical practice, i.e. patients enrolled at the
time of the diagnosis of cirrhosis. This might have artificially increased the
performance of the prognostic index, and should be mentioned in the discussion.
2. The performance characteristics of the index are globally modest: the AUROC
is inferior to that of other indexes such as the platelet count/spleen diameter ratio
(Giannini et al, ref. 4) or CT esophagography (see Kim et al Radiology
2007;242:759-768). This should be mentioned in the discussion
3. The other parameters, listed in Table 4, are also modest: the positive
likelihood ratios of the different cut-off values are rather low, and the negative
likelihood ratios are too high (except for the cut-off -0.3052; however the
specificity for this cut-off is extremely low). This should also be discussed
4. The study is retrospective. Prospective validation in an independent patient
population is mandatory. This is mentioned in the discussion, but the Authors
should state clearly that until this is done, the model should not be used as a
substitute for endoscopy.
Minor compulsory revisions
Table 2: Males (%) and Ascites (%). In reality, the actual numbers and not the %
are given
The English language needs careful checking (e.g. results, page 6, 3rd line from
bottom: I think that “dominated” really means “denominated”; page 7 , 5th line
from top: “significantly higher than platelet count” should be “significantly higher
than that for platelet count”. Similar corrections must be done in several parts
throughout the text)
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Predictors of Esophageal Varices in Patients With HBV-related Cirrhosis: A
retrospective study
Version: 1Date:8 September 2008
Reviewer: Roberto de Franchis
Reviewer's report:
The topic of predicting the presence of esophageal varices in patients with
cirrhosis before doing endoscopy is an important one, because, if an adequate
method could be developed for this task, this could greatly decrease the
workload of endoscopy units.
The paper by Hong et al. is yet another attempt to tackle this goal, and suffers
from the same limitations of several previous studies.
The Authors should be commended for a thorough statistical evaluation of the
performance of their model; however, some points need discussion:
Major compulsory revisions
1. The population is largely composed of patients with decompensated cirrhosis,
and only partially reflects the population in which an index to predict the presence
of varices would be mostly applied in clinical practice, i.e. patients enrolled at the
time of the diagnosis of cirrhosis. This might have artificially increased the
performance of the prognostic index, and should be mentioned in the discussion.
2. The performance characteristics of the index are globally modest: the AUROC
is inferior to that of other indexes such as the platelet count/spleen diameter ratio
(Giannini et al, ref. 4) or CT esophagography (see Kim et al Radiology
2007;242:759-768). This should be mentioned in the discussion
3. The other parameters, listed in Table 4, are also modest: the positive
likelihood ratios of the different cut-off values are rather low, and the negative
likelihood ratios are too high (except for the cut-off -0.3052; however the
specificity for this cut-off is extremely low). This should also be discussed
4. The study is retrospective. Prospective validation in an independent patient
population is mandatory. This is mentioned in the discussion, but the Authors
should state clearly that until this is done, the model should not be used as a
substitute for endoscopy.
Minor compulsory revisions
Table 2: Males (%) and Ascites (%). In reality, the actual numbers and not the %
are given
The English language needs careful checking (e.g. results, page 6, 3rd line from
bottom: I think that “dominated” really means “denominated”; page 7 , 5th line
from top: “significantly higher than platelet count” should be “significantly higher
than that for platelet count”. Similar corrections must be done in several parts
throughout the text)
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Predictors of Esophageal Varices in Patients With HBV-related Cirrhosis: A
retrospective study
Version: 1Date:8 September 2008
Reviewer: Roberto de Franchis
Reviewer's report:
The topic of predicting the presence of esophageal varices in patients with
cirrhosis before doing endoscopy is an important one, because, if an adequate
method could be developed for this task, this could greatly decrease the
workload of endoscopy units.
The paper by Hong et al. is yet another attempt to tackle this goal, and suffers
from the same limitations of several previous studies.
The Authors should be commended for a thorough statistical evaluation of the
performance of their model; however, some points need discussion:
Major compulsory revisions
1. The population is largely composed of patients with decompensated cirrhosis,
and only partially reflects the population in which an index to predict the presence
of varices would be mostly applied in clinical practice, i.e. patients enrolled at the
time of the diagnosis of cirrhosis. This might have artificially increased the
performance of the prognostic index, and should be mentioned in the discussion.
2. The performance characteristics of the index are globally modest: the AUROC
is inferior to that of other indexes such as the platelet count/spleen diameter ratio
(Giannini et al, ref. 4) or CT esophagography (see Kim et al Radiology
2007;242:759-768). This should be mentioned in the discussion
3. The other parameters, listed in Table 4, are also modest: the positive
likelihood ratios of the different cut-off values are rather low, and the negative
likelihood ratios are too high (except for the cut-off -0.3052; however the
specificity for this cut-off is extremely low). This should also be discussed
4. The study is retrospective. Prospective validation in an independent patient
population is mandatory. This is mentioned in the discussion, but the Authors
should state clearly that until this is done, the model should not be used as a
substitute for endoscopy.
Minor compulsory revisions
Table 2: Males (%) and Ascites (%). In reality, the actual numbers and not the %
are given
The English language needs careful checking (e.g. results, page 6, 3rd line from
bottom: I think that “dominated” really means “denominated”; page 7 , 5th line
from top: “significantly higher than platelet count” should be “significantly higher
than that for platelet count”. Similar corrections must be done in several parts
throughout the text)
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
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