Title: A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-
related unplanned readmissions and improved survival
Version: 1 Date: 28 Aug 2023
Reviewer's report:
The authors set out to test a specialized nurse-led clinic intervention to reduce hospital
readmissions in cirrhosis and improve survival.  The intervention is pragmatic and data are
needed on the feasibility, effectiveness, and cost-effectiveness of these types of interventions.
However, there are several study design and analysis issues that limit the generalizability and
interpretation of the results.
1. The readmission rate in the control arm was only 12.2%. This is well below what is reported
in the data. I suspect this is due to the large number of exclusion criteria and relatively low
MELD cohort.  Why were patients on antivirals for less than 12 months, or with stage II HE,
or recent TIPS excluded? Would provide that rationale in methods.  Would also need to discuss
low readmission rates in discussion.
2. The methods only describe descriptive statistics.  Mortality and readmission should be time
to event analysis to control for not everyone having the same amount of time to experience the
outcome.  Also the study period should be provided in the methods; over what time period were
participants enrolled as well as follow up time.
3. The authors mention SES in the introduction as a reason that these clinics were targeted but
then don’t provided in SES data. These are important contributors of readmission and survival.
4. The authors describe 5 key outcomes in Figure 4. Each of these need details in the methods
for how they were defined and analyzed.
5. Would expand Table 1 to include Charlson score, data on liver disease complications or Child
Pugh Score.
Title: A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-
related unplanned readmissions and improved survival
Version: 1 Date: 28 Aug 2023
Reviewer's report:
The authors set out to test a specialized nurse-led clinic intervention to reduce hospital
readmissions in cirrhosis and improve survival.  The intervention is pragmatic and data are
needed on the feasibility, effectiveness, and cost-effectiveness of these types of interventions.
However, there are several study design and analysis issues that limit the generalizability and
interpretation of the results.
1. The readmission rate in the control arm was only 12.2%. This is well below what is reported
in the data. I suspect this is due to the large number of exclusion criteria and relatively low
MELD cohort.  Why were patients on antivirals for less than 12 months, or with stage II HE,
or recent TIPS excluded? Would provide that rationale in methods.  Would also need to discuss
low readmission rates in discussion.
2. The methods only describe descriptive statistics.  Mortality and readmission should be time
to event analysis to control for not everyone having the same amount of time to experience the
outcome.  Also the study period should be provided in the methods; over what time period were
participants enrolled as well as follow up time.
3. The authors mention SES in the introduction as a reason that these clinics were targeted but
then don’t provided in SES data. These are important contributors of readmission and survival.
4. The authors describe 5 key outcomes in Figure 4. Each of these need details in the methods
for how they were defined and analyzed.
5. Would expand Table 1 to include Charlson score, data on liver disease complications or Child
Pugh Score.
Please review this paper.
user
Title: A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-
related unplanned readmissions and improved survival
Version: 1 Date: 28 Aug 2023
Reviewer's report:
The authors set out to test a specialized nurse-led clinic intervention to reduce hospital
readmissions in cirrhosis and improve survival.  The intervention is pragmatic and data are
needed on the feasibility, effectiveness, and cost-effectiveness of these types of interventions.
However, there are several study design and analysis issues that limit the generalizability and
interpretation of the results.
1. The readmission rate in the control arm was only 12.2%. This is well below what is reported
in the data. I suspect this is due to the large number of exclusion criteria and relatively low
MELD cohort.  Why were patients on antivirals for less than 12 months, or with stage II HE,
or recent TIPS excluded? Would provide that rationale in methods.  Would also need to discuss
low readmission rates in discussion.
2. The methods only describe descriptive statistics.  Mortality and readmission should be time
to event analysis to control for not everyone having the same amount of time to experience the
outcome.  Also the study period should be provided in the methods; over what time period were
participants enrolled as well as follow up time.
3. The authors mention SES in the introduction as a reason that these clinics were targeted but
then don’t provided in SES data. These are important contributors of readmission and survival.
4. The authors describe 5 key outcomes in Figure 4. Each of these need details in the methods
for how they were defined and analyzed.
5. Would expand Table 1 to include Charlson score, data on liver disease complications or Child
Pugh Score.
assistant