Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 08 May 2020
Reviewer's report:
The authors attempt to address the differences in haemostasis evaluation employing conventional
coagulations tests and ROTEM in ACLF and non-ACLF cirrhotic patients. They describesignificant differences that suggest the superiority of a viscoelastic test over CCT. This findingcould have signicant clinical implications.Several minor comments can be made to improve the manuscript.1.The authors compare patients with ACLF and those without. However, this Last group seemsunhomogeneous considering that some of the patients included had elective hospitalizations(TACE) while the others had non-ACLF acute decompensations. This fact difficult theinterpretation the findings of the study even more considering that patients considered fit to TACEcommonly have compensated cirrhosis. Please discuss.2.It would be very useful for the non-expert hepatologyst to explain why different tests arerequires to perform a proper ROTEM evaluation.3.The cause of hospitalization must be described on each group.4.Only 77 patients were included in the study (22 of them had ACLF). Thus, non-parametric testshould be employed to perform comparisons between groups and the variables must be expressedas median and IQR. At this respect special attention must be pay to the comparison between thoseACLF who bleed and those who did not.5.Line 210 (section 3.3): "the Non-ACLF group showed a significantly CT and higher MCF
compared to ACLF patients". It seems to me that in should say: "…showed a CT and MCF
significantly increased compared to ACLF patients"6.I recommend a title that stated better the most important findings of the study. Probablysomething similar to: "Rotational thrombelastometry (ROTEM) improves hemostasis assessmentcompared to conventional coagulation test in ACLF and non-ACLF patients".7.An additional table showing the results of the multivariate analysis of survival (OR and CI) mustbe added.8.The meaning of "POC test" (point of care test?) was not specified.9.The study of Kumar et al can be cited in the discussion section to reinforce the concept thatviscoelastic tests seems to be superior to conventional tests to evaluate the risk of bleeding and toguide the rational administration of hemoderivatives (doi: 10.1002/hep.30794).
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 thismanuscript, 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 interests.
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report.
(default)
Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 08 May 2020
Reviewer's report:
The authors attempt to address the differences in haemostasis evaluation employing conventional
coagulations tests and ROTEM in ACLF and non-ACLF cirrhotic patients. They describesignificant differences that suggest the superiority of a viscoelastic test over CCT. This findingcould have signicant clinical implications.Several minor comments can be made to improve the manuscript.1.The authors compare patients with ACLF and those without. However, this Last group seemsunhomogeneous considering that some of the patients included had elective hospitalizations(TACE) while the others had non-ACLF acute decompensations. This fact difficult theinterpretation the findings of the study even more considering that patients considered fit to TACEcommonly have compensated cirrhosis. Please discuss.2.It would be very useful for the non-expert hepatologyst to explain why different tests arerequires to perform a proper ROTEM evaluation.3.The cause of hospitalization must be described on each group.4.Only 77 patients were included in the study (22 of them had ACLF). Thus, non-parametric testshould be employed to perform comparisons between groups and the variables must be expressedas median and IQR. At this respect special attention must be pay to the comparison between thoseACLF who bleed and those who did not.5.Line 210 (section 3.3): "the Non-ACLF group showed a significantly CT and higher MCF
compared to ACLF patients". It seems to me that in should say: "…showed a CT and MCF
significantly increased compared to ACLF patients"6.I recommend a title that stated better the most important findings of the study. Probablysomething similar to: "Rotational thrombelastometry (ROTEM) improves hemostasis assessmentcompared to conventional coagulation test in ACLF and non-ACLF patients".7.An additional table showing the results of the multivariate analysis of survival (OR and CI) mustbe added.8.The meaning of "POC test" (point of care test?) was not specified.9.The study of Kumar et al can be cited in the discussion section to reinforce the concept thatviscoelastic tests seems to be superior to conventional tests to evaluate the risk of bleeding and toguide the rational administration of hemoderivatives (doi: 10.1002/hep.30794).
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 thismanuscript, 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 interests.
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report.
(default)
Please review this paper.
user
Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 08 May 2020
Reviewer's report:
The authors attempt to address the differences in haemostasis evaluation employing conventional
coagulations tests and ROTEM in ACLF and non-ACLF cirrhotic patients. They describesignificant differences that suggest the superiority of a viscoelastic test over CCT. This findingcould have signicant clinical implications.Several minor comments can be made to improve the manuscript.1.The authors compare patients with ACLF and those without. However, this Last group seemsunhomogeneous considering that some of the patients included had elective hospitalizations(TACE) while the others had non-ACLF acute decompensations. This fact difficult theinterpretation the findings of the study even more considering that patients considered fit to TACEcommonly have compensated cirrhosis. Please discuss.2.It would be very useful for the non-expert hepatologyst to explain why different tests arerequires to perform a proper ROTEM evaluation.3.The cause of hospitalization must be described on each group.4.Only 77 patients were included in the study (22 of them had ACLF). Thus, non-parametric testshould be employed to perform comparisons between groups and the variables must be expressedas median and IQR. At this respect special attention must be pay to the comparison between thoseACLF who bleed and those who did not.5.Line 210 (section 3.3): "the Non-ACLF group showed a significantly CT and higher MCF
compared to ACLF patients". It seems to me that in should say: "…showed a CT and MCF
significantly increased compared to ACLF patients"6.I recommend a title that stated better the most important findings of the study. Probablysomething similar to: "Rotational thrombelastometry (ROTEM) improves hemostasis assessmentcompared to conventional coagulation test in ACLF and non-ACLF patients".7.An additional table showing the results of the multivariate analysis of survival (OR and CI) mustbe added.8.The meaning of "POC test" (point of care test?) was not specified.9.The study of Kumar et al can be cited in the discussion section to reinforce the concept thatviscoelastic tests seems to be superior to conventional tests to evaluate the risk of bleeding and toguide the rational administration of hemoderivatives (doi: 10.1002/hep.30794).
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 thismanuscript, 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 interests.
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report.
(default)
assistant