Title: Effect of alcohol on clinical complications of hepatitis virus-induced liver cirrhosis: a
consecutive ten-year study
Version: 1 Date: 12 Dec 2021
Reviewer:  Antonio Mirijello
Reviewer's report:
The manuscript is interesting and addresses an hot topic in the field of hepatology: the
relationship and the effect of alcohol on the natural history of viral cirrhosis.
However, I have som concerns (MAJOR) that should be solved by Authors:
- Alcoholic liver disease (ALD):  this definition is extensively used throughout the text (abstract
and main body). However,  I would suggest to replace "alcoholic liver disease" with "alcohol-
induced liver disease" or "alcohol-associated liver disease".
- Alcohol abuse: this definition is extensively used throughout the text (abstract and main
body).  However, the DSM-5 has abandoned the dichotomy between alcohol abuse and alcohol
dependence and replaced them with the broader  definition of AUD (alcohol use diserder).  I
would suggest to Authors to replace "alcohol abuse" in the abstract and in the text with AUD or
excessive alcohol consumption  or heavy alcohol use, as appropriate.
-  INTRODUCTION, liner 13-16, the explanation od markers of alcohol abuse  lacks of
a reference. Please cite "Addolorato G, Vassallo GA, Mirijello A, Gasbarrini A. Diagnosis
and Management of Alcohol Use Disorder in Patients with Liver Disease: Lights and
Shadows. Neurotherapeutics. 2020 Jan;17(1):127-141. doi: 10.1007/s13311-019-00802-8.
PMID: 31713188; PMCID: PMC7007485".
- MATHERIAL AND METHODS:  speaking of  alcohol consumption and alcohol abstinence.
How did you record alcohol consumption and/or alcohol abstinence? Basing on patients report?
Basing on the report of a relative? By using TLFB?
- DISCUSSION, LIMITATIONS SECTION: The main limitation of this study is represented
by the retrospective design.  Authors should quote that the retrospective design of the study
represents by itself a limitation, give the lack of an a priori evaluating protocol.
In addition, Authors should also quote that the effect of alcohol abstinence on viral replication
and /or on the  antiviral treatment efficacy could not be explored by this  study design.
MINOR COMMENTS:
- INTRODUCTION, first line:  Would you like to mention the etiologies in order of prevalence?
Or alphabetically?
- MATHERIAL AND METHODS, first line: instead of saying "our Horpital", could you define
it: e.g. name, city, tertiary care, nr of beds, teaching, etc.
- DISCUSSION: What about other biomerkers of alcohol intake/alcohol abstinence, e.g.
Carbohydrate Deficient Transferrin (CDT)?
Title: Effect of alcohol on clinical complications of hepatitis virus-induced liver cirrhosis: a
consecutive ten-year study
Version: 1 Date: 12 Dec 2021
Reviewer:  Antonio Mirijello
Reviewer's report:
The manuscript is interesting and addresses an hot topic in the field of hepatology: the
relationship and the effect of alcohol on the natural history of viral cirrhosis.
However, I have som concerns (MAJOR) that should be solved by Authors:
- Alcoholic liver disease (ALD):  this definition is extensively used throughout the text (abstract
and main body). However,  I would suggest to replace "alcoholic liver disease" with "alcohol-
induced liver disease" or "alcohol-associated liver disease".
- Alcohol abuse: this definition is extensively used throughout the text (abstract and main
body).  However, the DSM-5 has abandoned the dichotomy between alcohol abuse and alcohol
dependence and replaced them with the broader  definition of AUD (alcohol use diserder).  I
would suggest to Authors to replace "alcohol abuse" in the abstract and in the text with AUD or
excessive alcohol consumption  or heavy alcohol use, as appropriate.
-  INTRODUCTION, liner 13-16, the explanation od markers of alcohol abuse  lacks of
a reference. Please cite "Addolorato G, Vassallo GA, Mirijello A, Gasbarrini A. Diagnosis
and Management of Alcohol Use Disorder in Patients with Liver Disease: Lights and
Shadows. Neurotherapeutics. 2020 Jan;17(1):127-141. doi: 10.1007/s13311-019-00802-8.
PMID: 31713188; PMCID: PMC7007485".
- MATHERIAL AND METHODS:  speaking of  alcohol consumption and alcohol abstinence.
How did you record alcohol consumption and/or alcohol abstinence? Basing on patients report?
Basing on the report of a relative? By using TLFB?
- DISCUSSION, LIMITATIONS SECTION: The main limitation of this study is represented
by the retrospective design.  Authors should quote that the retrospective design of the study
represents by itself a limitation, give the lack of an a priori evaluating protocol.
In addition, Authors should also quote that the effect of alcohol abstinence on viral replication
and /or on the  antiviral treatment efficacy could not be explored by this  study design.
MINOR COMMENTS:
- INTRODUCTION, first line:  Would you like to mention the etiologies in order of prevalence?
Or alphabetically?
- MATHERIAL AND METHODS, first line: instead of saying "our Horpital", could you define
it: e.g. name, city, tertiary care, nr of beds, teaching, etc.
- DISCUSSION: What about other biomerkers of alcohol intake/alcohol abstinence, e.g.
Carbohydrate Deficient Transferrin (CDT)?
Please review this paper.
user
Title: Effect of alcohol on clinical complications of hepatitis virus-induced liver cirrhosis: a
consecutive ten-year study
Version: 1 Date: 12 Dec 2021
Reviewer:  Antonio Mirijello
Reviewer's report:
The manuscript is interesting and addresses an hot topic in the field of hepatology: the
relationship and the effect of alcohol on the natural history of viral cirrhosis.
However, I have som concerns (MAJOR) that should be solved by Authors:
- Alcoholic liver disease (ALD):  this definition is extensively used throughout the text (abstract
and main body). However,  I would suggest to replace "alcoholic liver disease" with "alcohol-
induced liver disease" or "alcohol-associated liver disease".
- Alcohol abuse: this definition is extensively used throughout the text (abstract and main
body).  However, the DSM-5 has abandoned the dichotomy between alcohol abuse and alcohol
dependence and replaced them with the broader  definition of AUD (alcohol use diserder).  I
would suggest to Authors to replace "alcohol abuse" in the abstract and in the text with AUD or
excessive alcohol consumption  or heavy alcohol use, as appropriate.
-  INTRODUCTION, liner 13-16, the explanation od markers of alcohol abuse  lacks of
a reference. Please cite "Addolorato G, Vassallo GA, Mirijello A, Gasbarrini A. Diagnosis
and Management of Alcohol Use Disorder in Patients with Liver Disease: Lights and
Shadows. Neurotherapeutics. 2020 Jan;17(1):127-141. doi: 10.1007/s13311-019-00802-8.
PMID: 31713188; PMCID: PMC7007485".
- MATHERIAL AND METHODS:  speaking of  alcohol consumption and alcohol abstinence.
How did you record alcohol consumption and/or alcohol abstinence? Basing on patients report?
Basing on the report of a relative? By using TLFB?
- DISCUSSION, LIMITATIONS SECTION: The main limitation of this study is represented
by the retrospective design.  Authors should quote that the retrospective design of the study
represents by itself a limitation, give the lack of an a priori evaluating protocol.
In addition, Authors should also quote that the effect of alcohol abstinence on viral replication
and /or on the  antiviral treatment efficacy could not be explored by this  study design.
MINOR COMMENTS:
- INTRODUCTION, first line:  Would you like to mention the etiologies in order of prevalence?
Or alphabetically?
- MATHERIAL AND METHODS, first line: instead of saying "our Horpital", could you define
it: e.g. name, city, tertiary care, nr of beds, teaching, etc.
- DISCUSSION: What about other biomerkers of alcohol intake/alcohol abstinence, e.g.
Carbohydrate Deficient Transferrin (CDT)?
assistant