Title: Establishment of MELD-lactate clearance scoring system in predicting death risk of
critically ill cirrhotic patients
Version: 1 Date: 02 Mar 2022
Reviewer's report:
Review Gong et al.
Gong and colleagues conducted a retrospective study that investigated the predictive values of
lactate kinetics in ICU patients with liver cirrhosis. Furthermore, they created an easy to apply
scoring tool that predicts mortality and created a MELD-#LA score that was superior to other
established risk scores in predicting mortality in this collective.
The data was obtained not from the authors center, but from an openly available data-base.
Lactate is a well established, easy to use and interpret parameter that is widely available.
Although I like the idea of analyzing the dynamic of a parameter and correlating it with a specific
outcome, there are some major points that need to be addressed:
Major:
1. Please perform a major work-up of the language throughout the whole manuscript.
2. Introduction: Line 53: ICU mortality in patients with cirrhosis is high, but not every study
report’s mortality rates up to 87%. Please consider revising this part and use ranges instead
(studies report ICU mortality from XX% to XX%).
3. The MELD-Na score is also an important scoring tool that needs to be considered and analyzed
in the study. Please add this. Also: Since you used data not from your department, but from an
openly available data-base, please give the information on how the organ-allocation is made.
4. Study eligibility criteria: Line 99+100: ‘Patients over 100 years of age and liver cancer’
I assume the authors excluded patients over 100years and also patients liver cancer. Please
specify. Also illustrate the patient extraction with a consort figure. Did you exclude patients
with extrahepatic malignancy?
5. I don’t understand the definition of critically ill ICU patients (Line 121: critically ill patients
were regarded as patients with liver cirrhosis admitted to the ICU). So every patient was critically
ill?
6. Line 132: All patients were followed for at least 1 year. So you have follow up data from
every patient and there were no drop outs? Please specify.
7. Include the MELD score in your baseline characteristics.
8. Line 182: The authors conclude that a 1% increase lactate associates significantly with the
outcome. From a mathematical standpoint this makes sense. However, I am assume that no
patient had a change of 1% in Lactate. In this context I would like to see an additional figure
showing survival curves dependent on the Lactate changes (e.g. -20% change, 0% change, +20%
change).
9. Also create a survival figure using the MELD-#LA score, to illustrate how the increase of 1,
2 , 3, etc. points impacts survival.
Minor:
1. Discussion: The authors conclude that their score has a better predictive value than the SOFA
Score or the MELD Score. In fact, this is only so in this particular cohort. Since there are no
other studies with this Score, the authors cannot generalize to this timepoint.
Title: Establishment of MELD-lactate clearance scoring system in predicting death risk of
critically ill cirrhotic patients
Version: 1 Date: 02 Mar 2022
Reviewer's report:
Review Gong et al.
Gong and colleagues conducted a retrospective study that investigated the predictive values of
lactate kinetics in ICU patients with liver cirrhosis. Furthermore, they created an easy to apply
scoring tool that predicts mortality and created a MELD-#LA score that was superior to other
established risk scores in predicting mortality in this collective.
The data was obtained not from the authors center, but from an openly available data-base.
Lactate is a well established, easy to use and interpret parameter that is widely available.
Although I like the idea of analyzing the dynamic of a parameter and correlating it with a specific
outcome, there are some major points that need to be addressed:
Major:
1. Please perform a major work-up of the language throughout the whole manuscript.
2. Introduction: Line 53: ICU mortality in patients with cirrhosis is high, but not every study
report’s mortality rates up to 87%. Please consider revising this part and use ranges instead
(studies report ICU mortality from XX% to XX%).
3. The MELD-Na score is also an important scoring tool that needs to be considered and analyzed
in the study. Please add this. Also: Since you used data not from your department, but from an
openly available data-base, please give the information on how the organ-allocation is made.
4. Study eligibility criteria: Line 99+100: ‘Patients over 100 years of age and liver cancer’
I assume the authors excluded patients over 100years and also patients liver cancer. Please
specify. Also illustrate the patient extraction with a consort figure. Did you exclude patients
with extrahepatic malignancy?
5. I don’t understand the definition of critically ill ICU patients (Line 121: critically ill patients
were regarded as patients with liver cirrhosis admitted to the ICU). So every patient was critically
ill?
6. Line 132: All patients were followed for at least 1 year. So you have follow up data from
every patient and there were no drop outs? Please specify.
7. Include the MELD score in your baseline characteristics.
8. Line 182: The authors conclude that a 1% increase lactate associates significantly with the
outcome. From a mathematical standpoint this makes sense. However, I am assume that no
patient had a change of 1% in Lactate. In this context I would like to see an additional figure
showing survival curves dependent on the Lactate changes (e.g. -20% change, 0% change, +20%
change).
9. Also create a survival figure using the MELD-#LA score, to illustrate how the increase of 1,
2 , 3, etc. points impacts survival.
Minor:
1. Discussion: The authors conclude that their score has a better predictive value than the SOFA
Score or the MELD Score. In fact, this is only so in this particular cohort. Since there are no
other studies with this Score, the authors cannot generalize to this timepoint.
Please review this paper.
user
Title: Establishment of MELD-lactate clearance scoring system in predicting death risk of
critically ill cirrhotic patients
Version: 1 Date: 02 Mar 2022
Reviewer's report:
Review Gong et al.
Gong and colleagues conducted a retrospective study that investigated the predictive values of
lactate kinetics in ICU patients with liver cirrhosis. Furthermore, they created an easy to apply
scoring tool that predicts mortality and created a MELD-#LA score that was superior to other
established risk scores in predicting mortality in this collective.
The data was obtained not from the authors center, but from an openly available data-base.
Lactate is a well established, easy to use and interpret parameter that is widely available.
Although I like the idea of analyzing the dynamic of a parameter and correlating it with a specific
outcome, there are some major points that need to be addressed:
Major:
1. Please perform a major work-up of the language throughout the whole manuscript.
2. Introduction: Line 53: ICU mortality in patients with cirrhosis is high, but not every study
report’s mortality rates up to 87%. Please consider revising this part and use ranges instead
(studies report ICU mortality from XX% to XX%).
3. The MELD-Na score is also an important scoring tool that needs to be considered and analyzed
in the study. Please add this. Also: Since you used data not from your department, but from an
openly available data-base, please give the information on how the organ-allocation is made.
4. Study eligibility criteria: Line 99+100: ‘Patients over 100 years of age and liver cancer’
I assume the authors excluded patients over 100years and also patients liver cancer. Please
specify. Also illustrate the patient extraction with a consort figure. Did you exclude patients
with extrahepatic malignancy?
5. I don’t understand the definition of critically ill ICU patients (Line 121: critically ill patients
were regarded as patients with liver cirrhosis admitted to the ICU). So every patient was critically
ill?
6. Line 132: All patients were followed for at least 1 year. So you have follow up data from
every patient and there were no drop outs? Please specify.
7. Include the MELD score in your baseline characteristics.
8. Line 182: The authors conclude that a 1% increase lactate associates significantly with the
outcome. From a mathematical standpoint this makes sense. However, I am assume that no
patient had a change of 1% in Lactate. In this context I would like to see an additional figure
showing survival curves dependent on the Lactate changes (e.g. -20% change, 0% change, +20%
change).
9. Also create a survival figure using the MELD-#LA score, to illustrate how the increase of 1,
2 , 3, etc. points impacts survival.
Minor:
1. Discussion: The authors conclude that their score has a better predictive value than the SOFA
Score or the MELD Score. In fact, this is only so in this particular cohort. Since there are no
other studies with this Score, the authors cannot generalize to this timepoint.
assistant