Reviewer's report
Title:The galactose elimination capacity and mortality in 781 Danish patients
with newly-diagnosed liver cirrhosis: a cohort study
Version: 1Date:22 December 2008
Reviewer: Carlo Merkel
Reviewer's report:
The Authors assessed mortality in a large series of patients with a first diagnosis
of cirrhosis, in whom GEC was measured at the time of diagnosis. They
observed that short and long term mortality was related to GEC, particularly in
the low values.
The main strenght of this manuscript is the fact that this report is based on the
largest database of GEC in cirrhosis ever compiled. Amongf the weak points, I
would consider particularly the fact that the study is a retrospective analysis of of
data collected for different reasons, and therefore crtieria of inclusion are not
clearly established.
I would suggest the following comments for a possible improvement:
Major compulsory revisions:
1) Data should be reported with their confidence intervals
2) Survival in the various deciles of GEC should be reported as Kaplan-Meier
curves, since most readers are familiar with this way of reporting survival course
of patients.
Minor essential revisions:
1) Since the time of beginning of cirrhosis is difficult to define, as compensated
disease may last for 10 years, the principle of an inception cohort of patients
enrolled at the beginning of disease is hard to demonstrate. As the only definite
point in the natural history of cirrhosis is the time of the first decompensation, I
would suggest to make a further analysis considering as beginning of follow-up
the first decompensation (and GEC at the time of first decompensation).
2) I suggest to discuss in detail if it is reasonable to hypothesize that marginally
decreased values of GEC may be of value in predicting long-term outcome of a
compensated disease, of which the date of beginning is unknown, and the
remaining span of time in compensated disease ought to be predicted by this
test. At a first look at the results, it appears that when GEC is normal or
nearly-normal, 5-yr survival is the same for any value of GEC. This reinforce my
suggestion of assessing outcome from the first decompensation.
Discretionary revisions:
1) I would try to express clearly the concept that the relationship between liver
function and survival is more than a hypothesis, and that the real problems lay in
the way of evaluating derangement in liver function, and in the time-course of the
decrease in liver function, that may not be linear.
2) I would also discuss the fact that available literature is not concordant on the
additive value of GEC to the prognostic assessment obtained by conventional
liver function tests.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:The galactose elimination capacity and mortality in 781 Danish patients
with newly-diagnosed liver cirrhosis: a cohort study
Version: 1Date:22 December 2008
Reviewer: Carlo Merkel
Reviewer's report:
The Authors assessed mortality in a large series of patients with a first diagnosis
of cirrhosis, in whom GEC was measured at the time of diagnosis. They
observed that short and long term mortality was related to GEC, particularly in
the low values.
The main strenght of this manuscript is the fact that this report is based on the
largest database of GEC in cirrhosis ever compiled. Amongf the weak points, I
would consider particularly the fact that the study is a retrospective analysis of of
data collected for different reasons, and therefore crtieria of inclusion are not
clearly established.
I would suggest the following comments for a possible improvement:
Major compulsory revisions:
1) Data should be reported with their confidence intervals
2) Survival in the various deciles of GEC should be reported as Kaplan-Meier
curves, since most readers are familiar with this way of reporting survival course
of patients.
Minor essential revisions:
1) Since the time of beginning of cirrhosis is difficult to define, as compensated
disease may last for 10 years, the principle of an inception cohort of patients
enrolled at the beginning of disease is hard to demonstrate. As the only definite
point in the natural history of cirrhosis is the time of the first decompensation, I
would suggest to make a further analysis considering as beginning of follow-up
the first decompensation (and GEC at the time of first decompensation).
2) I suggest to discuss in detail if it is reasonable to hypothesize that marginally
decreased values of GEC may be of value in predicting long-term outcome of a
compensated disease, of which the date of beginning is unknown, and the
remaining span of time in compensated disease ought to be predicted by this
test. At a first look at the results, it appears that when GEC is normal or
nearly-normal, 5-yr survival is the same for any value of GEC. This reinforce my
suggestion of assessing outcome from the first decompensation.
Discretionary revisions:
1) I would try to express clearly the concept that the relationship between liver
function and survival is more than a hypothesis, and that the real problems lay in
the way of evaluating derangement in liver function, and in the time-course of the
decrease in liver function, that may not be linear.
2) I would also discuss the fact that available literature is not concordant on the
additive value of GEC to the prognostic assessment obtained by conventional
liver function tests.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:The galactose elimination capacity and mortality in 781 Danish patients
with newly-diagnosed liver cirrhosis: a cohort study
Version: 1Date:22 December 2008
Reviewer: Carlo Merkel
Reviewer's report:
The Authors assessed mortality in a large series of patients with a first diagnosis
of cirrhosis, in whom GEC was measured at the time of diagnosis. They
observed that short and long term mortality was related to GEC, particularly in
the low values.
The main strenght of this manuscript is the fact that this report is based on the
largest database of GEC in cirrhosis ever compiled. Amongf the weak points, I
would consider particularly the fact that the study is a retrospective analysis of of
data collected for different reasons, and therefore crtieria of inclusion are not
clearly established.
I would suggest the following comments for a possible improvement:
Major compulsory revisions:
1) Data should be reported with their confidence intervals
2) Survival in the various deciles of GEC should be reported as Kaplan-Meier
curves, since most readers are familiar with this way of reporting survival course
of patients.
Minor essential revisions:
1) Since the time of beginning of cirrhosis is difficult to define, as compensated
disease may last for 10 years, the principle of an inception cohort of patients
enrolled at the beginning of disease is hard to demonstrate. As the only definite
point in the natural history of cirrhosis is the time of the first decompensation, I
would suggest to make a further analysis considering as beginning of follow-up
the first decompensation (and GEC at the time of first decompensation).
2) I suggest to discuss in detail if it is reasonable to hypothesize that marginally
decreased values of GEC may be of value in predicting long-term outcome of a
compensated disease, of which the date of beginning is unknown, and the
remaining span of time in compensated disease ought to be predicted by this
test. At a first look at the results, it appears that when GEC is normal or
nearly-normal, 5-yr survival is the same for any value of GEC. This reinforce my
suggestion of assessing outcome from the first decompensation.
Discretionary revisions:
1) I would try to express clearly the concept that the relationship between liver
function and survival is more than a hypothesis, and that the real problems lay in
the way of evaluating derangement in liver function, and in the time-course of the
decrease in liver function, that may not be linear.
2) I would also discuss the fact that available literature is not concordant on the
additive value of GEC to the prognostic assessment obtained by conventional
liver function tests.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
assistant