Reviewer’s report
Title: Percentage of small platelets on peripheral blood smear and Child-Turcott-Pugh class can predict  
the presence of oesophageal varices in newly diagnosed patients with cirrhosis: development of a  
prediction model for resource limited settings
Version: 0 Date: 12 Jun 2019
Reviewer: Kevin Roedl
Reviewer's report:
Thank you for the opportunity to review this manuscript. 
The manuscript by Perera K. and colleagues explores the prediction of oesophageal varices (OV) in  
patients with newley diagnosed liver cirrhosis via peripheral blood smear in combination with Child-
Turcott-Pugh class (CTP). The main finding was that the model could accurately predict OV with a  
sensitivity  of  89%.  This  method  is  especially  interesting  for  resource  limited  settings.  Early  
identification of patients at risk for gastro-intestinal bleeding is a cornerstone. The shown method could  
be quite interesting for resource limited settings where a endoscopy unit is not available. Especially for  
early treatment initiation and referral to a specialized center this is from large interest. 
I enjoyed reviewing this manuscript, nevertheless I have a few concerns.
Abstract:
-Please add the country where the study was undertaken.
-On which timepoints where the hematological parameters taken, admission?
Introduction:
-Please describe the presence/epidemiology of liver cirrhosis, in respect to the resource limited  
setting.
-Is the method used easy to learn? Does this have to be performed by an haematologist? If so this  
would be a massive limitation for your findings.
Methods:
-How was liver cirrhosis diagnosed? (Clinical parameters, Ultrasound, CT, Biopsy ..)
-Was a diagnostic algorithm used?
-Page 9 - Data analysis: .. p value of 0.05… - please add „<"
Results:
-Can you please provide median age besides only age groups - I think according to the small  
number of patients that brings no further relevant information
-What was the underlying cause of liver cirrhosis (Viral, alcoholic, etc) - please add
-Could  you  add  more  information  on  the  baseline  characteristics  of  the  study population?  
Probably in a table (Age/Male-Female/CTP - subclasses/cause of cirrhosis etc.)
-There is a large number of tables - probably some of them could be in the supplementary  
materials.
Discussion:
-Please add short introduction in the Discussion. 
-Is  there  an  explanation  why indices  obtained  by automatic  analyzers  did  not  shown  any  
prediction?
-How  many  patients  had  acute  decompensation  on  admission,  when  liver  cirrhosis  was  
diagnosed
-Did you further had the chance, even this would not be possible in the resource limited setting,  
also use Fibroscan to correlate your findings in our cohort?
-Also a possible explanation why Thrombocytopenia was not predictive - could be that all  
patients with sings of Infection were exluded? Please add and comment.
-Please add if the method could be used by "everyone" or only by expert hematologists. This  
would have a big influence your findings
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If  
your reply is yes to any, please give details below.
I declare that I have no competing interest
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title: Percentage of small platelets on peripheral blood smear and Child-Turcott-Pugh class can predict  
the presence of oesophageal varices in newly diagnosed patients with cirrhosis: development of a  
prediction model for resource limited settings
Version: 0 Date: 12 Jun 2019
Reviewer: Kevin Roedl
Reviewer's report:
Thank you for the opportunity to review this manuscript. 
The manuscript by Perera K. and colleagues explores the prediction of oesophageal varices (OV) in  
patients with newley diagnosed liver cirrhosis via peripheral blood smear in combination with Child-
Turcott-Pugh class (CTP). The main finding was that the model could accurately predict OV with a  
sensitivity  of  89%.  This  method  is  especially  interesting  for  resource  limited  settings.  Early  
identification of patients at risk for gastro-intestinal bleeding is a cornerstone. The shown method could  
be quite interesting for resource limited settings where a endoscopy unit is not available. Especially for  
early treatment initiation and referral to a specialized center this is from large interest. 
I enjoyed reviewing this manuscript, nevertheless I have a few concerns.
Abstract:
-Please add the country where the study was undertaken.
-On which timepoints where the hematological parameters taken, admission?
Introduction:
-Please describe the presence/epidemiology of liver cirrhosis, in respect to the resource limited  
setting.
-Is the method used easy to learn? Does this have to be performed by an haematologist? If so this  
would be a massive limitation for your findings.
Methods:
-How was liver cirrhosis diagnosed? (Clinical parameters, Ultrasound, CT, Biopsy ..)
-Was a diagnostic algorithm used?
-Page 9 - Data analysis: .. p value of 0.05… - please add „<"
Results:
-Can you please provide median age besides only age groups - I think according to the small  
number of patients that brings no further relevant information
-What was the underlying cause of liver cirrhosis (Viral, alcoholic, etc) - please add
-Could  you  add  more  information  on  the  baseline  characteristics  of  the  study population?  
Probably in a table (Age/Male-Female/CTP - subclasses/cause of cirrhosis etc.)
-There is a large number of tables - probably some of them could be in the supplementary  
materials.
Discussion:
-Please add short introduction in the Discussion. 
-Is  there  an  explanation  why indices  obtained  by automatic  analyzers  did  not  shown  any  
prediction?
-How  many  patients  had  acute  decompensation  on  admission,  when  liver  cirrhosis  was  
diagnosed
-Did you further had the chance, even this would not be possible in the resource limited setting,  
also use Fibroscan to correlate your findings in our cohort?
-Also a possible explanation why Thrombocytopenia was not predictive - could be that all  
patients with sings of Infection were exluded? Please add and comment.
-Please add if the method could be used by "everyone" or only by expert hematologists. This  
would have a big influence your findings
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If  
your reply is yes to any, please give details below.
I declare that I have no competing interest
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’s report
Title: Percentage of small platelets on peripheral blood smear and Child-Turcott-Pugh class can predict  
the presence of oesophageal varices in newly diagnosed patients with cirrhosis: development of a  
prediction model for resource limited settings
Version: 0 Date: 12 Jun 2019
Reviewer: Kevin Roedl
Reviewer's report:
Thank you for the opportunity to review this manuscript. 
The manuscript by Perera K. and colleagues explores the prediction of oesophageal varices (OV) in  
patients with newley diagnosed liver cirrhosis via peripheral blood smear in combination with Child-
Turcott-Pugh class (CTP). The main finding was that the model could accurately predict OV with a  
sensitivity  of  89%.  This  method  is  especially  interesting  for  resource  limited  settings.  Early  
identification of patients at risk for gastro-intestinal bleeding is a cornerstone. The shown method could  
be quite interesting for resource limited settings where a endoscopy unit is not available. Especially for  
early treatment initiation and referral to a specialized center this is from large interest. 
I enjoyed reviewing this manuscript, nevertheless I have a few concerns.
Abstract:
-Please add the country where the study was undertaken.
-On which timepoints where the hematological parameters taken, admission?
Introduction:
-Please describe the presence/epidemiology of liver cirrhosis, in respect to the resource limited  
setting.
-Is the method used easy to learn? Does this have to be performed by an haematologist? If so this  
would be a massive limitation for your findings.
Methods:
-How was liver cirrhosis diagnosed? (Clinical parameters, Ultrasound, CT, Biopsy ..)
-Was a diagnostic algorithm used?
-Page 9 - Data analysis: .. p value of 0.05… - please add „<"
Results:
-Can you please provide median age besides only age groups - I think according to the small  
number of patients that brings no further relevant information
-What was the underlying cause of liver cirrhosis (Viral, alcoholic, etc) - please add
-Could  you  add  more  information  on  the  baseline  characteristics  of  the  study population?  
Probably in a table (Age/Male-Female/CTP - subclasses/cause of cirrhosis etc.)
-There is a large number of tables - probably some of them could be in the supplementary  
materials.
Discussion:
-Please add short introduction in the Discussion. 
-Is  there  an  explanation  why indices  obtained  by automatic  analyzers  did  not  shown  any  
prediction?
-How  many  patients  had  acute  decompensation  on  admission,  when  liver  cirrhosis  was  
diagnosed
-Did you further had the chance, even this would not be possible in the resource limited setting,  
also use Fibroscan to correlate your findings in our cohort?
-Also a possible explanation why Thrombocytopenia was not predictive - could be that all  
patients with sings of Infection were exluded? Please add and comment.
-Please add if the method could be used by "everyone" or only by expert hematologists. This  
would have a big influence your findings
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If  
your reply is yes to any, please give details below.
I declare that I have no competing interest
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
assistant