Title: Albumin infusion may decrease the mortality of hypoalbuminemia patients with severe
acute pancreatitis: a retrospective cohort study
Version: 3 Date: 05 Feb 2023
Reviewer's report:
The manuscript has improved, it is interesting and adds major knowledge to this field. However
as listed below several of my points from first revision still need some more adjustments.
Point 1. Still there are several wordings indication causality ex in the title (Albumin infusion
decreases mortality…). The study investigates correlations. Please do not use the word “effect
of”  or similar.
Point 4. CRP levels are not available for all patients according to the authors reply. This is
very disappointing.  Standard treatment of acute pancreatitis includes measurement of CRP and
for patients with severe AP this is done repeatedly. How come there are no CRP levels for
patients included in the study? What do the authors think about earlier publications that have
demonstrated that a CRP/alb ratio rather than CRP or alb separatly predicts poor outcome? This
major disadvantage of the study is not even discussed in discussion part.
If CRP is available for most patients, it would be possible to see if maximum CRP during the
first week differed between patients with/without hypoalbuminemia. If CRP levels can not be
included this need to be discussed in discussion section including references to publications
enhancing the relation between CRP/alb to be more important than CRP och alb separately.
Point 10. Please indicate in table tex (bottom of table) that all laboratory values are from
admission in Table 1 and similar (except albmin in Table 3)
Point 6. The impact of including patients who died within 30 days in the cost and length of stay
analysis should be discussed in discussion (indicating actual differences in Length of stay and
costs to be even larger)
When discussed about hypoalbuminemia in AP the authors should also reflect upon causes
for hypoalbuminemi already existing in patients getting AP such as malnutrition etc. These
preexisting conditions might affect the outcome and introduce a bias- this should be discussed.
Still there are abbreviations not spelled out first time used (f ex IPN, ACS in methods)
One sentence in methods need to be rewritten since it is hard to understand
“The primary treatment measures for AP patients include early fluid resuscitation, nutrition
support (parenteral or enteral) and analgesia(4, 28-30).”
Title: Albumin infusion may decrease the mortality of hypoalbuminemia patients with severe
acute pancreatitis: a retrospective cohort study
Version: 3 Date: 05 Feb 2023
Reviewer's report:
The manuscript has improved, it is interesting and adds major knowledge to this field. However
as listed below several of my points from first revision still need some more adjustments.
Point 1. Still there are several wordings indication causality ex in the title (Albumin infusion
decreases mortality…). The study investigates correlations. Please do not use the word “effect
of”  or similar.
Point 4. CRP levels are not available for all patients according to the authors reply. This is
very disappointing.  Standard treatment of acute pancreatitis includes measurement of CRP and
for patients with severe AP this is done repeatedly. How come there are no CRP levels for
patients included in the study? What do the authors think about earlier publications that have
demonstrated that a CRP/alb ratio rather than CRP or alb separatly predicts poor outcome? This
major disadvantage of the study is not even discussed in discussion part.
If CRP is available for most patients, it would be possible to see if maximum CRP during the
first week differed between patients with/without hypoalbuminemia. If CRP levels can not be
included this need to be discussed in discussion section including references to publications
enhancing the relation between CRP/alb to be more important than CRP och alb separately.
Point 10. Please indicate in table tex (bottom of table) that all laboratory values are from
admission in Table 1 and similar (except albmin in Table 3)
Point 6. The impact of including patients who died within 30 days in the cost and length of stay
analysis should be discussed in discussion (indicating actual differences in Length of stay and
costs to be even larger)
When discussed about hypoalbuminemia in AP the authors should also reflect upon causes
for hypoalbuminemi already existing in patients getting AP such as malnutrition etc. These
preexisting conditions might affect the outcome and introduce a bias- this should be discussed.
Still there are abbreviations not spelled out first time used (f ex IPN, ACS in methods)
One sentence in methods need to be rewritten since it is hard to understand
“The primary treatment measures for AP patients include early fluid resuscitation, nutrition
support (parenteral or enteral) and analgesia(4, 28-30).”
Please review this paper.
user
Title: Albumin infusion may decrease the mortality of hypoalbuminemia patients with severe
acute pancreatitis: a retrospective cohort study
Version: 3 Date: 05 Feb 2023
Reviewer's report:
The manuscript has improved, it is interesting and adds major knowledge to this field. However
as listed below several of my points from first revision still need some more adjustments.
Point 1. Still there are several wordings indication causality ex in the title (Albumin infusion
decreases mortality…). The study investigates correlations. Please do not use the word “effect
of”  or similar.
Point 4. CRP levels are not available for all patients according to the authors reply. This is
very disappointing.  Standard treatment of acute pancreatitis includes measurement of CRP and
for patients with severe AP this is done repeatedly. How come there are no CRP levels for
patients included in the study? What do the authors think about earlier publications that have
demonstrated that a CRP/alb ratio rather than CRP or alb separatly predicts poor outcome? This
major disadvantage of the study is not even discussed in discussion part.
If CRP is available for most patients, it would be possible to see if maximum CRP during the
first week differed between patients with/without hypoalbuminemia. If CRP levels can not be
included this need to be discussed in discussion section including references to publications
enhancing the relation between CRP/alb to be more important than CRP och alb separately.
Point 10. Please indicate in table tex (bottom of table) that all laboratory values are from
admission in Table 1 and similar (except albmin in Table 3)
Point 6. The impact of including patients who died within 30 days in the cost and length of stay
analysis should be discussed in discussion (indicating actual differences in Length of stay and
costs to be even larger)
When discussed about hypoalbuminemia in AP the authors should also reflect upon causes
for hypoalbuminemi already existing in patients getting AP such as malnutrition etc. These
preexisting conditions might affect the outcome and introduce a bias- this should be discussed.
Still there are abbreviations not spelled out first time used (f ex IPN, ACS in methods)
One sentence in methods need to be rewritten since it is hard to understand
“The primary treatment measures for AP patients include early fluid resuscitation, nutrition
support (parenteral or enteral) and analgesia(4, 28-30).”
assistant