Title: A clinical predictive score of high liver iron content in metabolic hyperferritinemia; a
retrospective cohort pilot study
Version: 2 Date: 07 Mar 2025
Reviewer's report:
The paper reports on using ROC curve analysis to improve the ability of MR Liver Iron
estimation to predict hepatic iron overload.  The patient profile is a large group of French patients
who have been diagnosed with dysmetabolic syndrome which was first described in France.
The liver histology differs from C282Y linked hemochromatosis and it has not been established
that venesection improves outcomes.
It would be expected that a positive family history, high ferritin and transferrin saturation would
be correlated with liver iron concentration.  The ROC analysis provides a statistical proof
although the key variable the area under the curve (AOC) gives only an acceptable result, a AOC
> 0.8 would have been preferred.
This use of scoring systems are rarely used by physicians.  In some studies, an app is created to
simplify the calculations and interpretation.   In this study, the analysis would likely be done by
the radiologist and thus the paper may be better suited to a short report in an imaging journal.
The impact of the study is low because the need for venesection is not clear and some patients
get worse with venesection.
The references should include a large study from France by LeGac et al that demonstrated that
most French patients undergoing venesections for iron overload, do not have iron overload.
Ailiment Pharmacol Ther 2022 doi: 10.1111/apt.16775 .
Title: A clinical predictive score of high liver iron content in metabolic hyperferritinemia; a
retrospective cohort pilot study
Version: 2 Date: 07 Mar 2025
Reviewer's report:
The paper reports on using ROC curve analysis to improve the ability of MR Liver Iron
estimation to predict hepatic iron overload.  The patient profile is a large group of French patients
who have been diagnosed with dysmetabolic syndrome which was first described in France.
The liver histology differs from C282Y linked hemochromatosis and it has not been established
that venesection improves outcomes.
It would be expected that a positive family history, high ferritin and transferrin saturation would
be correlated with liver iron concentration.  The ROC analysis provides a statistical proof
although the key variable the area under the curve (AOC) gives only an acceptable result, a AOC
> 0.8 would have been preferred.
This use of scoring systems are rarely used by physicians.  In some studies, an app is created to
simplify the calculations and interpretation.   In this study, the analysis would likely be done by
the radiologist and thus the paper may be better suited to a short report in an imaging journal.
The impact of the study is low because the need for venesection is not clear and some patients
get worse with venesection.
The references should include a large study from France by LeGac et al that demonstrated that
most French patients undergoing venesections for iron overload, do not have iron overload.
Ailiment Pharmacol Ther 2022 doi: 10.1111/apt.16775 .
Please review this paper.
user
Title: A clinical predictive score of high liver iron content in metabolic hyperferritinemia; a
retrospective cohort pilot study
Version: 2 Date: 07 Mar 2025
Reviewer's report:
The paper reports on using ROC curve analysis to improve the ability of MR Liver Iron
estimation to predict hepatic iron overload.  The patient profile is a large group of French patients
who have been diagnosed with dysmetabolic syndrome which was first described in France.
The liver histology differs from C282Y linked hemochromatosis and it has not been established
that venesection improves outcomes.
It would be expected that a positive family history, high ferritin and transferrin saturation would
be correlated with liver iron concentration.  The ROC analysis provides a statistical proof
although the key variable the area under the curve (AOC) gives only an acceptable result, a AOC
> 0.8 would have been preferred.
This use of scoring systems are rarely used by physicians.  In some studies, an app is created to
simplify the calculations and interpretation.   In this study, the analysis would likely be done by
the radiologist and thus the paper may be better suited to a short report in an imaging journal.
The impact of the study is low because the need for venesection is not clear and some patients
get worse with venesection.
The references should include a large study from France by LeGac et al that demonstrated that
most French patients undergoing venesections for iron overload, do not have iron overload.
Ailiment Pharmacol Ther 2022 doi: 10.1111/apt.16775 .
assistant