Title: Validation of a new simple scoring system to predict spontaneous bacterial peritonitis in
patients with cirrhosis and ascites
Version: 1 Date: 21 May 2023
Reviewer's report:
1. Authors need to further strengthen the rationale of the study by highlighting the importance
of non-invasive scoring for the prediction of SBP. The issues related to diagnostic paracentesis
should be elaborated further.
2. Was ascetic fluid analysis including detection of RBC count apart from WBC count to rule
out spontaneous and iatrogenic hemorrhagic ascites (post paracentesis)? As in the case of the
hemorrhagic component it will affect the CRP levels a main component of the Mansoura scoring
system.
3. Were patients having underlying evidence of HCC excluded too? as HCC will again affect
the CRP level?
4. Were all sub-sets of SBP like Culture-negative Neutrocytic ascites excluded?
5. Were patients of cirrhosis having rifaximin as part of their routine treatment to prevent HE
excluded? As current evidence suggests the reduction in SBP with rifaximin.
6. For validation of the diagnostic performance of the Mansoura scoring system larger and multi-
centric samples are required.
7. Discussion section needs to be more relevant to the current evidence.
Title: Validation of a new simple scoring system to predict spontaneous bacterial peritonitis in
patients with cirrhosis and ascites
Version: 1 Date: 21 May 2023
Reviewer's report:
1. Authors need to further strengthen the rationale of the study by highlighting the importance
of non-invasive scoring for the prediction of SBP. The issues related to diagnostic paracentesis
should be elaborated further.
2. Was ascetic fluid analysis including detection of RBC count apart from WBC count to rule
out spontaneous and iatrogenic hemorrhagic ascites (post paracentesis)? As in the case of the
hemorrhagic component it will affect the CRP levels a main component of the Mansoura scoring
system.
3. Were patients having underlying evidence of HCC excluded too? as HCC will again affect
the CRP level?
4. Were all sub-sets of SBP like Culture-negative Neutrocytic ascites excluded?
5. Were patients of cirrhosis having rifaximin as part of their routine treatment to prevent HE
excluded? As current evidence suggests the reduction in SBP with rifaximin.
6. For validation of the diagnostic performance of the Mansoura scoring system larger and multi-
centric samples are required.
7. Discussion section needs to be more relevant to the current evidence.
Please review this paper.
user
Title: Validation of a new simple scoring system to predict spontaneous bacterial peritonitis in
patients with cirrhosis and ascites
Version: 1 Date: 21 May 2023
Reviewer's report:
1. Authors need to further strengthen the rationale of the study by highlighting the importance
of non-invasive scoring for the prediction of SBP. The issues related to diagnostic paracentesis
should be elaborated further.
2. Was ascetic fluid analysis including detection of RBC count apart from WBC count to rule
out spontaneous and iatrogenic hemorrhagic ascites (post paracentesis)? As in the case of the
hemorrhagic component it will affect the CRP levels a main component of the Mansoura scoring
system.
3. Were patients having underlying evidence of HCC excluded too? as HCC will again affect
the CRP level?
4. Were all sub-sets of SBP like Culture-negative Neutrocytic ascites excluded?
5. Were patients of cirrhosis having rifaximin as part of their routine treatment to prevent HE
excluded? As current evidence suggests the reduction in SBP with rifaximin.
6. For validation of the diagnostic performance of the Mansoura scoring system larger and multi-
centric samples are required.
7. Discussion section needs to be more relevant to the current evidence.
assistant