Title: Incidence and Risk factors of Fasting Hyperglycaemia Following First-attack Acute
Pancreatitis Before Discharge: A Retrospective Study
Version: 3 Date: 19 Dec 2022
Reviewer's report:
The manuscript has improved substantially, especially the introduction.Several adequate
references have been added.
There are still some concerns.
Patients with more than 2 datapoints missing were excluded. How were 1 missing datapoint
handled in statistical analysis, especially in multivariate logistic regression analysis?
The CTSI score and Figure 3 is not in line with the aim of the manuscript and does not add
important information – please exclude this from the manuscript.
Timing of elevated FPG (page 8 line 176) is unclear from the manuscript text (only described
in response to rewievers)
Please specify timing (was it the day of discharge?) in methods and also in results. The same is
true for page 9 line 185 where the definition of time is unclear.
Line 178-179 indicates patients with in-hospital mortality are not excluded from this study,
please modify.
The study population had a relatively low percentage of patients with MSAP compared to other
population-based studies (for example Sternby H, Ann Surg 2019;270:348-355, Schepers NJ,
et al Gut 2019;68:1044-1051, Garg PK et al  Gastroenterology 2019;156:2008-2023.)- please
include this in discussion
The term initial AP is used in the manuscript- it is not clear what this means (first AP episode,
initial phase of AP?) please rewrite.
Discussion
Line 198-199 does not add information and should be excluded.
Line 230-231 there are grammatical errors in allusion (FPG is not affected by the discharge from
hospital- rather from the recovery from the acute inflammatory disease)  please rewrite
Line 298-299: This sentence is not correct. In all recent guidelines including Revised Atlanta
gudielines, IAP/APA guidelines and more- CT is not recommended in general during the first
3-5 days, Only if needed for diagnostic uncertainty or for patients with complications (MSAP
or SAP)-  Reference 40 is not a guideline.
Since there was no correlation between severity and FPG- there is no reason to look at different
CT findings in relation to FPG. As the authors already concluded- the sample size is far too small
for this analysis. The analysis showing that the proportion of individuals with a CTSI score of
#6 in the fasting hyperglycaemia group was significantly higher than that in the control group
could be left, but all subanalysis of this should be excluded. Please exclude line 298-318 and also
the substudy only including patients with necrosis. This substudy is not defined or mentioned
in methods or results.
There are parts of discussion that is irrelevant or written in such a way that it should be excluded
especially lines 323-326
The text in general, but especially in discussion, needs a languish revision and editorial revision
The authors use expressions as “initial AP” as they meant first time AP and not the initial phase
of AP. Similarly “early stage AP” is not defined and makes the text indistinct.
For exampel page 9 line 185 it is unclear if this sentence should be related to the group of patients
with  “other etiologies”  or all patients with AP
“AP clinical grade” is not a correct expression if you refer to “severity of AP”
There are similar languish unclarities throughout the manuscript.
292 “and most of them are AP patients.” Does not make sense.
332- 335 the text is misleading since s-Ca levels refer to the active AP phase and the
hyperglycemia refers to patients just recovered from AP. The meaning should be similar to:
“ In patients who during AP had lower serum Calcium levels- fasting hyperglycemia were less
common.”
357-358 is also not correct.
The text in conclusion is not supported by results.
Title: Incidence and Risk factors of Fasting Hyperglycaemia Following First-attack Acute
Pancreatitis Before Discharge: A Retrospective Study
Version: 3 Date: 19 Dec 2022
Reviewer's report:
The manuscript has improved substantially, especially the introduction.Several adequate
references have been added.
There are still some concerns.
Patients with more than 2 datapoints missing were excluded. How were 1 missing datapoint
handled in statistical analysis, especially in multivariate logistic regression analysis?
The CTSI score and Figure 3 is not in line with the aim of the manuscript and does not add
important information – please exclude this from the manuscript.
Timing of elevated FPG (page 8 line 176) is unclear from the manuscript text (only described
in response to rewievers)
Please specify timing (was it the day of discharge?) in methods and also in results. The same is
true for page 9 line 185 where the definition of time is unclear.
Line 178-179 indicates patients with in-hospital mortality are not excluded from this study,
please modify.
The study population had a relatively low percentage of patients with MSAP compared to other
population-based studies (for example Sternby H, Ann Surg 2019;270:348-355, Schepers NJ,
et al Gut 2019;68:1044-1051, Garg PK et al  Gastroenterology 2019;156:2008-2023.)- please
include this in discussion
The term initial AP is used in the manuscript- it is not clear what this means (first AP episode,
initial phase of AP?) please rewrite.
Discussion
Line 198-199 does not add information and should be excluded.
Line 230-231 there are grammatical errors in allusion (FPG is not affected by the discharge from
hospital- rather from the recovery from the acute inflammatory disease)  please rewrite
Line 298-299: This sentence is not correct. In all recent guidelines including Revised Atlanta
gudielines, IAP/APA guidelines and more- CT is not recommended in general during the first
3-5 days, Only if needed for diagnostic uncertainty or for patients with complications (MSAP
or SAP)-  Reference 40 is not a guideline.
Since there was no correlation between severity and FPG- there is no reason to look at different
CT findings in relation to FPG. As the authors already concluded- the sample size is far too small
for this analysis. The analysis showing that the proportion of individuals with a CTSI score of
#6 in the fasting hyperglycaemia group was significantly higher than that in the control group
could be left, but all subanalysis of this should be excluded. Please exclude line 298-318 and also
the substudy only including patients with necrosis. This substudy is not defined or mentioned
in methods or results.
There are parts of discussion that is irrelevant or written in such a way that it should be excluded
especially lines 323-326
The text in general, but especially in discussion, needs a languish revision and editorial revision
The authors use expressions as “initial AP” as they meant first time AP and not the initial phase
of AP. Similarly “early stage AP” is not defined and makes the text indistinct.
For exampel page 9 line 185 it is unclear if this sentence should be related to the group of patients
with  “other etiologies”  or all patients with AP
“AP clinical grade” is not a correct expression if you refer to “severity of AP”
There are similar languish unclarities throughout the manuscript.
292 “and most of them are AP patients.” Does not make sense.
332- 335 the text is misleading since s-Ca levels refer to the active AP phase and the
hyperglycemia refers to patients just recovered from AP. The meaning should be similar to:
“ In patients who during AP had lower serum Calcium levels- fasting hyperglycemia were less
common.”
357-358 is also not correct.
The text in conclusion is not supported by results.
Please review this paper.
user
Title: Incidence and Risk factors of Fasting Hyperglycaemia Following First-attack Acute
Pancreatitis Before Discharge: A Retrospective Study
Version: 3 Date: 19 Dec 2022
Reviewer's report:
The manuscript has improved substantially, especially the introduction.Several adequate
references have been added.
There are still some concerns.
Patients with more than 2 datapoints missing were excluded. How were 1 missing datapoint
handled in statistical analysis, especially in multivariate logistic regression analysis?
The CTSI score and Figure 3 is not in line with the aim of the manuscript and does not add
important information – please exclude this from the manuscript.
Timing of elevated FPG (page 8 line 176) is unclear from the manuscript text (only described
in response to rewievers)
Please specify timing (was it the day of discharge?) in methods and also in results. The same is
true for page 9 line 185 where the definition of time is unclear.
Line 178-179 indicates patients with in-hospital mortality are not excluded from this study,
please modify.
The study population had a relatively low percentage of patients with MSAP compared to other
population-based studies (for example Sternby H, Ann Surg 2019;270:348-355, Schepers NJ,
et al Gut 2019;68:1044-1051, Garg PK et al  Gastroenterology 2019;156:2008-2023.)- please
include this in discussion
The term initial AP is used in the manuscript- it is not clear what this means (first AP episode,
initial phase of AP?) please rewrite.
Discussion
Line 198-199 does not add information and should be excluded.
Line 230-231 there are grammatical errors in allusion (FPG is not affected by the discharge from
hospital- rather from the recovery from the acute inflammatory disease)  please rewrite
Line 298-299: This sentence is not correct. In all recent guidelines including Revised Atlanta
gudielines, IAP/APA guidelines and more- CT is not recommended in general during the first
3-5 days, Only if needed for diagnostic uncertainty or for patients with complications (MSAP
or SAP)-  Reference 40 is not a guideline.
Since there was no correlation between severity and FPG- there is no reason to look at different
CT findings in relation to FPG. As the authors already concluded- the sample size is far too small
for this analysis. The analysis showing that the proportion of individuals with a CTSI score of
#6 in the fasting hyperglycaemia group was significantly higher than that in the control group
could be left, but all subanalysis of this should be excluded. Please exclude line 298-318 and also
the substudy only including patients with necrosis. This substudy is not defined or mentioned
in methods or results.
There are parts of discussion that is irrelevant or written in such a way that it should be excluded
especially lines 323-326
The text in general, but especially in discussion, needs a languish revision and editorial revision
The authors use expressions as “initial AP” as they meant first time AP and not the initial phase
of AP. Similarly “early stage AP” is not defined and makes the text indistinct.
For exampel page 9 line 185 it is unclear if this sentence should be related to the group of patients
with  “other etiologies”  or all patients with AP
“AP clinical grade” is not a correct expression if you refer to “severity of AP”
There are similar languish unclarities throughout the manuscript.
292 “and most of them are AP patients.” Does not make sense.
332- 335 the text is misleading since s-Ca levels refer to the active AP phase and the
hyperglycemia refers to patients just recovered from AP. The meaning should be similar to:
“ In patients who during AP had lower serum Calcium levels- fasting hyperglycemia were less
common.”
357-358 is also not correct.
The text in conclusion is not supported by results.
assistant