Title: Osteosarcopenia predicts poor survival in patients with cirrhosis: a retrospective study
Version: 1 Date: 08 Apr 2023
Reviewer's report:
Comments to Authors
Authors described the manuscript entitled ‘Osteosarcopenia predicts poor survival in patients
with cirrhosis’. There were some concerns to be addressed.
1. The title should include the study design (retrospective design and so on).
2. The patient selection process should be clarified and a figure should be included to help
readers understand.
3. Authors should clarify whether they used fibrosis markers such as FIB-4 and liver stiffness
measurement (FibroScan) to diagnose cirrhosis. The value of these markers could be included
in Table.
4. I did not understand the rationale for including patients with HCC in this study, given that
cirrhosis patients with HCC have a poor prognosis, as shown in Table 2. Moreover, the treatment
for HCC could strongly affect the present results. Although the authors excluded patients with
advanced HCC, the occurrence of HCC is more likely in patients after curative treatment than in
those without a history of HCC. Furthermore, malignant tumors are generally strongly associated
with osteosarcopenia, which could confound the results. Therefore, I suggest that the authors
exclude patients with HCC and conduct statistical analyses in cirrhosis patients without HCC.
In this connection, although the authors concluded that osteosarcopenia was significantly and
independently associated with mortality in patients with cirrhosis, I do not think this conclusion
can be drawn from the present results, given the confounding effects of HCC and the possible
association between malignant tumors and osteosarcopenia. Therefore, I strongly recommend
that the authors exclude patients with HCC and revise their conclusion based on the analysis of
cirrhosis patients without HCC.
5. In Figures 2 and 3, the authors compared the survival curve between two groups. However,
this analysis may be flawed. Instead, the authors should use the log-rank test to compare survival
among all three groups. Additionally, the authors should use a multiple comparison procedure
(Bonferroni method, Holm method, and so on) to account for the possibility of false-positive
results.
6. As the authors mentioned malnutrition in their study, they should clarify the number of
patients who received BCAA supplements.
7. The conclusion section is too lengthy. The authors should consider summarizing their findings
more succinctly and briefly.
Title: Osteosarcopenia predicts poor survival in patients with cirrhosis: a retrospective study
Version: 1 Date: 08 Apr 2023
Reviewer's report:
Comments to Authors
Authors described the manuscript entitled ‘Osteosarcopenia predicts poor survival in patients
with cirrhosis’. There were some concerns to be addressed.
1. The title should include the study design (retrospective design and so on).
2. The patient selection process should be clarified and a figure should be included to help
readers understand.
3. Authors should clarify whether they used fibrosis markers such as FIB-4 and liver stiffness
measurement (FibroScan) to diagnose cirrhosis. The value of these markers could be included
in Table.
4. I did not understand the rationale for including patients with HCC in this study, given that
cirrhosis patients with HCC have a poor prognosis, as shown in Table 2. Moreover, the treatment
for HCC could strongly affect the present results. Although the authors excluded patients with
advanced HCC, the occurrence of HCC is more likely in patients after curative treatment than in
those without a history of HCC. Furthermore, malignant tumors are generally strongly associated
with osteosarcopenia, which could confound the results. Therefore, I suggest that the authors
exclude patients with HCC and conduct statistical analyses in cirrhosis patients without HCC.
In this connection, although the authors concluded that osteosarcopenia was significantly and
independently associated with mortality in patients with cirrhosis, I do not think this conclusion
can be drawn from the present results, given the confounding effects of HCC and the possible
association between malignant tumors and osteosarcopenia. Therefore, I strongly recommend
that the authors exclude patients with HCC and revise their conclusion based on the analysis of
cirrhosis patients without HCC.
5. In Figures 2 and 3, the authors compared the survival curve between two groups. However,
this analysis may be flawed. Instead, the authors should use the log-rank test to compare survival
among all three groups. Additionally, the authors should use a multiple comparison procedure
(Bonferroni method, Holm method, and so on) to account for the possibility of false-positive
results.
6. As the authors mentioned malnutrition in their study, they should clarify the number of
patients who received BCAA supplements.
7. The conclusion section is too lengthy. The authors should consider summarizing their findings
more succinctly and briefly.
Please review this paper.
user
Title: Osteosarcopenia predicts poor survival in patients with cirrhosis: a retrospective study
Version: 1 Date: 08 Apr 2023
Reviewer's report:
Comments to Authors
Authors described the manuscript entitled ‘Osteosarcopenia predicts poor survival in patients
with cirrhosis’. There were some concerns to be addressed.
1. The title should include the study design (retrospective design and so on).
2. The patient selection process should be clarified and a figure should be included to help
readers understand.
3. Authors should clarify whether they used fibrosis markers such as FIB-4 and liver stiffness
measurement (FibroScan) to diagnose cirrhosis. The value of these markers could be included
in Table.
4. I did not understand the rationale for including patients with HCC in this study, given that
cirrhosis patients with HCC have a poor prognosis, as shown in Table 2. Moreover, the treatment
for HCC could strongly affect the present results. Although the authors excluded patients with
advanced HCC, the occurrence of HCC is more likely in patients after curative treatment than in
those without a history of HCC. Furthermore, malignant tumors are generally strongly associated
with osteosarcopenia, which could confound the results. Therefore, I suggest that the authors
exclude patients with HCC and conduct statistical analyses in cirrhosis patients without HCC.
In this connection, although the authors concluded that osteosarcopenia was significantly and
independently associated with mortality in patients with cirrhosis, I do not think this conclusion
can be drawn from the present results, given the confounding effects of HCC and the possible
association between malignant tumors and osteosarcopenia. Therefore, I strongly recommend
that the authors exclude patients with HCC and revise their conclusion based on the analysis of
cirrhosis patients without HCC.
5. In Figures 2 and 3, the authors compared the survival curve between two groups. However,
this analysis may be flawed. Instead, the authors should use the log-rank test to compare survival
among all three groups. Additionally, the authors should use a multiple comparison procedure
(Bonferroni method, Holm method, and so on) to account for the possibility of false-positive
results.
6. As the authors mentioned malnutrition in their study, they should clarify the number of
patients who received BCAA supplements.
7. The conclusion section is too lengthy. The authors should consider summarizing their findings
more succinctly and briefly.
assistant