Title: Scoring System for Predicting 90-Day Mortality of In-hospital Liver Cirrhosis Patients
at Cipto Mangunkusumo Hospital
Version: 1 Date: 03 Feb 2023
Reviewer's report:
This is a prospective cohort study investigating predictors of mortality in patients with liver
cirrhosis admitted to the Cipto Mangunkusomo Hosp in Jakarta in 2019. The authors examined
factors that could predict 90 d mortality. They examined demographic, clinic and lab data and
patients were monitored for 90d after admission. Cox regression analysis was then performed
to examined independent predictors. The overall mortality was 42% and the main factors were
MELD, CTP score and leukocyte count. A scorecard was developed for risk. The AUC for the
three was 0.921 and patients could be categorized as low risk (0-3) (4-18% mortality), moderate
risk (5-6) (40-54% mortality) or high risk 8-11 (78-95% mortality).
Comments
1. This is a commendable study that is of practical utility for a country like Indonesia, however
some improvements can be made
2. Only baseline data was collected and since patients status changes over time, changes in the
variables may also be useful as predictors. Were these collected? And were they analysed?
3. The standard of care management for each of these complications was not stated, eg
hematemesis and melaena – presumably endoscopy was performed ± EVL? Did all patients have
this done, variceal bleeding was present in %? What was the time from bleeding to endoscopy
(<24h ? >24h) since this has a bearing on mortality. Were all patients resuscitated according to
a standard protocol? Was is the protocol (this should be in the supplement). Similarly, protoocol
management of ascites, SBP and HE should be stated and included in supplement
4. The variables for CTP score and MELD score both include bilirubin and INR hence there is a
repetition of the variable in the cox regression. This should be corrected by using the individual
components of the MELD and CTP score and subjecting to cox regression. Alternatively, using
either CTP or MELD may solve the problem.
5. Non B non C is not really a terminology for liver cirrhosis that is commonly used. Metabolic
syndrome is likely to be a significant risk factor and this category may need some re-assignment
based on metabolic liver disease
Title: Scoring System for Predicting 90-Day Mortality of In-hospital Liver Cirrhosis Patients
at Cipto Mangunkusumo Hospital
Version: 1 Date: 03 Feb 2023
Reviewer's report:
This is a prospective cohort study investigating predictors of mortality in patients with liver
cirrhosis admitted to the Cipto Mangunkusomo Hosp in Jakarta in 2019. The authors examined
factors that could predict 90 d mortality. They examined demographic, clinic and lab data and
patients were monitored for 90d after admission. Cox regression analysis was then performed
to examined independent predictors. The overall mortality was 42% and the main factors were
MELD, CTP score and leukocyte count. A scorecard was developed for risk. The AUC for the
three was 0.921 and patients could be categorized as low risk (0-3) (4-18% mortality), moderate
risk (5-6) (40-54% mortality) or high risk 8-11 (78-95% mortality).
Comments
1. This is a commendable study that is of practical utility for a country like Indonesia, however
some improvements can be made
2. Only baseline data was collected and since patients status changes over time, changes in the
variables may also be useful as predictors. Were these collected? And were they analysed?
3. The standard of care management for each of these complications was not stated, eg
hematemesis and melaena – presumably endoscopy was performed ± EVL? Did all patients have
this done, variceal bleeding was present in %? What was the time from bleeding to endoscopy
(<24h ? >24h) since this has a bearing on mortality. Were all patients resuscitated according to
a standard protocol? Was is the protocol (this should be in the supplement). Similarly, protoocol
management of ascites, SBP and HE should be stated and included in supplement
4. The variables for CTP score and MELD score both include bilirubin and INR hence there is a
repetition of the variable in the cox regression. This should be corrected by using the individual
components of the MELD and CTP score and subjecting to cox regression. Alternatively, using
either CTP or MELD may solve the problem.
5. Non B non C is not really a terminology for liver cirrhosis that is commonly used. Metabolic
syndrome is likely to be a significant risk factor and this category may need some re-assignment
based on metabolic liver disease
Please review this paper.
user
Title: Scoring System for Predicting 90-Day Mortality of In-hospital Liver Cirrhosis Patients
at Cipto Mangunkusumo Hospital
Version: 1 Date: 03 Feb 2023
Reviewer's report:
This is a prospective cohort study investigating predictors of mortality in patients with liver
cirrhosis admitted to the Cipto Mangunkusomo Hosp in Jakarta in 2019. The authors examined
factors that could predict 90 d mortality. They examined demographic, clinic and lab data and
patients were monitored for 90d after admission. Cox regression analysis was then performed
to examined independent predictors. The overall mortality was 42% and the main factors were
MELD, CTP score and leukocyte count. A scorecard was developed for risk. The AUC for the
three was 0.921 and patients could be categorized as low risk (0-3) (4-18% mortality), moderate
risk (5-6) (40-54% mortality) or high risk 8-11 (78-95% mortality).
Comments
1. This is a commendable study that is of practical utility for a country like Indonesia, however
some improvements can be made
2. Only baseline data was collected and since patients status changes over time, changes in the
variables may also be useful as predictors. Were these collected? And were they analysed?
3. The standard of care management for each of these complications was not stated, eg
hematemesis and melaena – presumably endoscopy was performed ± EVL? Did all patients have
this done, variceal bleeding was present in %? What was the time from bleeding to endoscopy
(<24h ? >24h) since this has a bearing on mortality. Were all patients resuscitated according to
a standard protocol? Was is the protocol (this should be in the supplement). Similarly, protoocol
management of ascites, SBP and HE should be stated and included in supplement
4. The variables for CTP score and MELD score both include bilirubin and INR hence there is a
repetition of the variable in the cox regression. This should be corrected by using the individual
components of the MELD and CTP score and subjecting to cox regression. Alternatively, using
either CTP or MELD may solve the problem.
5. Non B non C is not really a terminology for liver cirrhosis that is commonly used. Metabolic
syndrome is likely to be a significant risk factor and this category may need some re-assignment
based on metabolic liver disease
assistant