Title: Association Between International Normalized Ratio-to-Albumin Ratio and Mortality
in Critically Ill Patients with Gastrointestinal Bleeding: A Retrospective MIMIC-IV Database
Study
Version: 0 Date: 24 Jun 2025
Reviewer's report:
Thank you for the opportunity to review this manuscript. While the study addresses an important
clinical question, I have a major concern regarding the central conclusion. The data presented
do not convincingly demonstrate that the proposed PTAR score offers a meaningful advantage
over using the INR value alone for prognosis.
My primary points are as follows:
Lack of Superior Predictive Performance: The core issue is that the newly established PTAR
marker does not outperform the standalone INR. The AUC for PTAR at 28 days is 0.691, which
is only negligibly higher than the 0.683 for INR. More importantly, the 95% confidence intervals
show substantial overlap (PTAR: 0.658–0.724 vs. INR: 0.650–0.717). This strongly suggests
that the difference between the two models is not statistically significant. I would recommend
the authors perform a DeLong test to formally compare the AUCs, as it is highly probable the
p-value will be greater than 0.05.
Redundancy of the Marker: PTAR is a composite marker derived from both INR and albumin. A
new marker that adds a layer of complexity (i.e., requiring an additional variable and calculation)
should offer a clear and significant improvement in performance to justify its clinical use. As the
predictive accuracy is virtually identical to that of INR alone, PTAR appears to be a redundant
indicator.
Given these points, I am not convinced that the findings of this manuscript provide significant
clinical value. The introduction of a more complex prognostic score without a demonstrable
improvement in accuracy is unlikely to change clinical practice.
Title: Association Between International Normalized Ratio-to-Albumin Ratio and Mortality
in Critically Ill Patients with Gastrointestinal Bleeding: A Retrospective MIMIC-IV Database
Study
Version: 0 Date: 24 Jun 2025
Reviewer's report:
Thank you for the opportunity to review this manuscript. While the study addresses an important
clinical question, I have a major concern regarding the central conclusion. The data presented
do not convincingly demonstrate that the proposed PTAR score offers a meaningful advantage
over using the INR value alone for prognosis.
My primary points are as follows:
Lack of Superior Predictive Performance: The core issue is that the newly established PTAR
marker does not outperform the standalone INR. The AUC for PTAR at 28 days is 0.691, which
is only negligibly higher than the 0.683 for INR. More importantly, the 95% confidence intervals
show substantial overlap (PTAR: 0.658–0.724 vs. INR: 0.650–0.717). This strongly suggests
that the difference between the two models is not statistically significant. I would recommend
the authors perform a DeLong test to formally compare the AUCs, as it is highly probable the
p-value will be greater than 0.05.
Redundancy of the Marker: PTAR is a composite marker derived from both INR and albumin. A
new marker that adds a layer of complexity (i.e., requiring an additional variable and calculation)
should offer a clear and significant improvement in performance to justify its clinical use. As the
predictive accuracy is virtually identical to that of INR alone, PTAR appears to be a redundant
indicator.
Given these points, I am not convinced that the findings of this manuscript provide significant
clinical value. The introduction of a more complex prognostic score without a demonstrable
improvement in accuracy is unlikely to change clinical practice.
Please review this paper.
user
Title: Association Between International Normalized Ratio-to-Albumin Ratio and Mortality
in Critically Ill Patients with Gastrointestinal Bleeding: A Retrospective MIMIC-IV Database
Study
Version: 0 Date: 24 Jun 2025
Reviewer's report:
Thank you for the opportunity to review this manuscript. While the study addresses an important
clinical question, I have a major concern regarding the central conclusion. The data presented
do not convincingly demonstrate that the proposed PTAR score offers a meaningful advantage
over using the INR value alone for prognosis.
My primary points are as follows:
Lack of Superior Predictive Performance: The core issue is that the newly established PTAR
marker does not outperform the standalone INR. The AUC for PTAR at 28 days is 0.691, which
is only negligibly higher than the 0.683 for INR. More importantly, the 95% confidence intervals
show substantial overlap (PTAR: 0.658–0.724 vs. INR: 0.650–0.717). This strongly suggests
that the difference between the two models is not statistically significant. I would recommend
the authors perform a DeLong test to formally compare the AUCs, as it is highly probable the
p-value will be greater than 0.05.
Redundancy of the Marker: PTAR is a composite marker derived from both INR and albumin. A
new marker that adds a layer of complexity (i.e., requiring an additional variable and calculation)
should offer a clear and significant improvement in performance to justify its clinical use. As the
predictive accuracy is virtually identical to that of INR alone, PTAR appears to be a redundant
indicator.
Given these points, I am not convinced that the findings of this manuscript provide significant
clinical value. The introduction of a more complex prognostic score without a demonstrable
improvement in accuracy is unlikely to change clinical practice.
assistant