Title: A rapid preliminary prediction model for intestinal necrosis in acute mesenteric ischemia:
a retrospective study
Version: 2 Date: 17 Feb 2021
Reviewer's report:
The authors provide an interesting study on a crucial outcome of mesenteric ischemia: intestinal
necrosis. Although retrospective, the sample population is rather large. However, presentation
of the results can be improved, as well as discussion on recent studies on the intestinal necrosis
outcome.
Here are my comments in detail:
- P3L9 : “other methods”, please specify. Notably, the authors could mention the recent
implementation of intestinal stroke centers providing 24/7 care of mesenteric ischemia (PMID
29776790 and PMID 25466834) and including antibiotics (PMID 30538292)
- P5L95: please specify whether all specimens were specifically reviewed in order to rule out
superficial necrosis and confirm full thickness small bowel wall necrosis. Or discuss in the
limitation paragraph
- Methods: please clarify how you constructed the score, what was the formula used for
calculation based on the logistic regression scores (intercept…
- Discussion : The authors omit to discuss several recent studies on predictors of intestinal
necrosis in AMI. Notably, numerous studies identified lactate levels as major and independent
biomarker of intestinal necrosis (PMID 31934635 and 31361977 and 31205904 and 28266590).
The authors should discuss why they could not study lactate in their study and how this stands
as a limitation. Further, they should open the discussion on recent interventions that have
shown to reduce the occurence of necrosis (improve diagnostic delays (PMID 33156109), oral
antibiotics (PMID 30538292), revascularization, intestinal stroke centers(PMID 29776790 and
PMID 25466834) and confront these novel practices to their past experience in their center and
how they and the readers could improve their management.
- Table1: Please provide percentages instead of ratios, Please clarify if intervention refers
to revascularization, Please discuss why patients operated on for necrosis are not offered
anticoagulation and intervention in your center.
- Table 3. Multivariate analysis should best be performed including variables associated with
necrosis in univariate analysis (for example, therapy variables, PT, Cr) or known risk factors for
necrosis (origin of AMI). Or explain why these variables were excluded from the final model.
Title: A rapid preliminary prediction model for intestinal necrosis in acute mesenteric ischemia:
a retrospective study
Version: 2 Date: 17 Feb 2021
Reviewer's report:
The authors provide an interesting study on a crucial outcome of mesenteric ischemia: intestinal
necrosis. Although retrospective, the sample population is rather large. However, presentation
of the results can be improved, as well as discussion on recent studies on the intestinal necrosis
outcome.
Here are my comments in detail:
- P3L9 : “other methods”, please specify. Notably, the authors could mention the recent
implementation of intestinal stroke centers providing 24/7 care of mesenteric ischemia (PMID
29776790 and PMID 25466834) and including antibiotics (PMID 30538292)
- P5L95: please specify whether all specimens were specifically reviewed in order to rule out
superficial necrosis and confirm full thickness small bowel wall necrosis. Or discuss in the
limitation paragraph
- Methods: please clarify how you constructed the score, what was the formula used for
calculation based on the logistic regression scores (intercept…
- Discussion : The authors omit to discuss several recent studies on predictors of intestinal
necrosis in AMI. Notably, numerous studies identified lactate levels as major and independent
biomarker of intestinal necrosis (PMID 31934635 and 31361977 and 31205904 and 28266590).
The authors should discuss why they could not study lactate in their study and how this stands
as a limitation. Further, they should open the discussion on recent interventions that have
shown to reduce the occurence of necrosis (improve diagnostic delays (PMID 33156109), oral
antibiotics (PMID 30538292), revascularization, intestinal stroke centers(PMID 29776790 and
PMID 25466834) and confront these novel practices to their past experience in their center and
how they and the readers could improve their management.
- Table1: Please provide percentages instead of ratios, Please clarify if intervention refers
to revascularization, Please discuss why patients operated on for necrosis are not offered
anticoagulation and intervention in your center.
- Table 3. Multivariate analysis should best be performed including variables associated with
necrosis in univariate analysis (for example, therapy variables, PT, Cr) or known risk factors for
necrosis (origin of AMI). Or explain why these variables were excluded from the final model.
Please review this paper.
user
Title: A rapid preliminary prediction model for intestinal necrosis in acute mesenteric ischemia:
a retrospective study
Version: 2 Date: 17 Feb 2021
Reviewer's report:
The authors provide an interesting study on a crucial outcome of mesenteric ischemia: intestinal
necrosis. Although retrospective, the sample population is rather large. However, presentation
of the results can be improved, as well as discussion on recent studies on the intestinal necrosis
outcome.
Here are my comments in detail:
- P3L9 : “other methods”, please specify. Notably, the authors could mention the recent
implementation of intestinal stroke centers providing 24/7 care of mesenteric ischemia (PMID
29776790 and PMID 25466834) and including antibiotics (PMID 30538292)
- P5L95: please specify whether all specimens were specifically reviewed in order to rule out
superficial necrosis and confirm full thickness small bowel wall necrosis. Or discuss in the
limitation paragraph
- Methods: please clarify how you constructed the score, what was the formula used for
calculation based on the logistic regression scores (intercept…
- Discussion : The authors omit to discuss several recent studies on predictors of intestinal
necrosis in AMI. Notably, numerous studies identified lactate levels as major and independent
biomarker of intestinal necrosis (PMID 31934635 and 31361977 and 31205904 and 28266590).
The authors should discuss why they could not study lactate in their study and how this stands
as a limitation. Further, they should open the discussion on recent interventions that have
shown to reduce the occurence of necrosis (improve diagnostic delays (PMID 33156109), oral
antibiotics (PMID 30538292), revascularization, intestinal stroke centers(PMID 29776790 and
PMID 25466834) and confront these novel practices to their past experience in their center and
how they and the readers could improve their management.
- Table1: Please provide percentages instead of ratios, Please clarify if intervention refers
to revascularization, Please discuss why patients operated on for necrosis are not offered
anticoagulation and intervention in your center.
- Table 3. Multivariate analysis should best be performed including variables associated with
necrosis in univariate analysis (for example, therapy variables, PT, Cr) or known risk factors for
necrosis (origin of AMI). Or explain why these variables were excluded from the final model.
assistant