Reviewer ’s report  
 
Title:  Risk Factors For Mortality Among Patients Admitted With Upper Gastrointestinal 
Bleeding At A Tertiary Hospital: A Prospective Cohort Study  
 
Version: 0 Date: 13 Apr 2017 
 
Reviewer:  Chieh -Chang  Chen  
 
Reviewer’s report:  
 
This study enrolled 170 patients with upper gastrointestinal (UGI) bleeding. They investigated 
the causes of UGI bleeidng and risk factors associated with 60 -day mortality in Tanzania.  
 
The following comments are for the reference of au thors:  
 
1. As the aurthor's siad, "Many risk factors for mortality have been found from different 
studies. A number of risk scores have been developed". The aurthors have better to 
emphasize the reasons why they have to investigate risk factors in Tanzania and the study 
may help other health resource limited area to stratify their patients with UGI bleeding.  
 
2. The UGI bleeding patient with co -morbidities have poor outcome, therefore the co -
morbidity of study participants needs to be clearly defined. The aut hors did not provide 
the definitions of encephalopathy, chronic liver disease, and renal insufficiency.  
 
3. The authors should address how they treat the study participants. Were all of them 
receive standardized treatment ? The results of the study would be  biased when the 
treatment differences other than endoscopy are not put into analysis.  
 
4. The authors used medians/interquartile ranges to describe demography of the study 
participants (Table 1 or Table 2). In a study enrolling 170 patients, why didn't aut hors use 
mean/standard deviation ?  
 
5. The authors stated elevated serum ALT level was associated with mortality. How was the 
cut of the value of ALT level chosen? Serum bilirubin and ALT level could be raised in 
patients with liver ischemia. Besides, hemod ynamic shock is an important prognostic 
factor in scoring systems such as Rockall score or Blatchford score. I would suggest 
authors to investigate the impact of hemodynamic shock on outcome.  
 
6. In table 2, the median of arterial oxygen saturation was 100% in both survival and 
mortality groups and the interquartile ranges were 100%, too. Is it correct that statistical 
analysis result showed p value was 0.035?  
 
7. The blatchford score is a non -endoscopy risk scoring system. Half of the study 
participtants in the presented study didn't have endoscopy. I will suggest authors to 
compare the predictive value between blatchford score and the parameters found by the 
investigators.  
 
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.  
 
Unable to assess  
 
Are 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 further 
assessment in your commen ts to the editors.  
 
I am abl e to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration 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 this 
manuscript, 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.  
 
No 
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted o n the website along with the authors' 
responses. 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/ ). I under stand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Risk Factors For Mortality Among Patients Admitted With Upper Gastrointestinal 
Bleeding At A Tertiary Hospital: A Prospective Cohort Study  
 
Version: 0 Date: 13 Apr 2017 
 
Reviewer:  Chieh -Chang  Chen  
 
Reviewer’s report:  
 
This study enrolled 170 patients with upper gastrointestinal (UGI) bleeding. They investigated 
the causes of UGI bleeidng and risk factors associated with 60 -day mortality in Tanzania.  
 
The following comments are for the reference of au thors:  
 
1. As the aurthor's siad, "Many risk factors for mortality have been found from different 
studies. A number of risk scores have been developed". The aurthors have better to 
emphasize the reasons why they have to investigate risk factors in Tanzania and the study 
may help other health resource limited area to stratify their patients with UGI bleeding.  
 
2. The UGI bleeding patient with co -morbidities have poor outcome, therefore the co -
morbidity of study participants needs to be clearly defined. The aut hors did not provide 
the definitions of encephalopathy, chronic liver disease, and renal insufficiency.  
 
3. The authors should address how they treat the study participants. Were all of them 
receive standardized treatment ? The results of the study would be  biased when the 
treatment differences other than endoscopy are not put into analysis.  
 
4. The authors used medians/interquartile ranges to describe demography of the study 
participants (Table 1 or Table 2). In a study enrolling 170 patients, why didn't aut hors use 
mean/standard deviation ?  
 
5. The authors stated elevated serum ALT level was associated with mortality. How was the 
cut of the value of ALT level chosen? Serum bilirubin and ALT level could be raised in 
patients with liver ischemia. Besides, hemod ynamic shock is an important prognostic 
factor in scoring systems such as Rockall score or Blatchford score. I would suggest 
authors to investigate the impact of hemodynamic shock on outcome.  
 
6. In table 2, the median of arterial oxygen saturation was 100% in both survival and 
mortality groups and the interquartile ranges were 100%, too. Is it correct that statistical 
analysis result showed p value was 0.035?  
 
7. The blatchford score is a non -endoscopy risk scoring system. Half of the study 
participtants in the presented study didn't have endoscopy. I will suggest authors to 
compare the predictive value between blatchford score and the parameters found by the 
investigators.  
 
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.  
 
Unable to assess  
 
Are 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 further 
assessment in your commen ts to the editors.  
 
I am abl e to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration 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 this 
manuscript, 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.  
 
No 
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted o n the website along with the authors' 
responses. 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/ ). I under stand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Risk Factors For Mortality Among Patients Admitted With Upper Gastrointestinal 
Bleeding At A Tertiary Hospital: A Prospective Cohort Study  
 
Version: 0 Date: 13 Apr 2017 
 
Reviewer:  Chieh -Chang  Chen  
 
Reviewer’s report:  
 
This study enrolled 170 patients with upper gastrointestinal (UGI) bleeding. They investigated 
the causes of UGI bleeidng and risk factors associated with 60 -day mortality in Tanzania.  
 
The following comments are for the reference of au thors:  
 
1. As the aurthor's siad, "Many risk factors for mortality have been found from different 
studies. A number of risk scores have been developed". The aurthors have better to 
emphasize the reasons why they have to investigate risk factors in Tanzania and the study 
may help other health resource limited area to stratify their patients with UGI bleeding.  
 
2. The UGI bleeding patient with co -morbidities have poor outcome, therefore the co -
morbidity of study participants needs to be clearly defined. The aut hors did not provide 
the definitions of encephalopathy, chronic liver disease, and renal insufficiency.  
 
3. The authors should address how they treat the study participants. Were all of them 
receive standardized treatment ? The results of the study would be  biased when the 
treatment differences other than endoscopy are not put into analysis.  
 
4. The authors used medians/interquartile ranges to describe demography of the study 
participants (Table 1 or Table 2). In a study enrolling 170 patients, why didn't aut hors use 
mean/standard deviation ?  
 
5. The authors stated elevated serum ALT level was associated with mortality. How was the 
cut of the value of ALT level chosen? Serum bilirubin and ALT level could be raised in 
patients with liver ischemia. Besides, hemod ynamic shock is an important prognostic 
factor in scoring systems such as Rockall score or Blatchford score. I would suggest 
authors to investigate the impact of hemodynamic shock on outcome.  
 
6. In table 2, the median of arterial oxygen saturation was 100% in both survival and 
mortality groups and the interquartile ranges were 100%, too. Is it correct that statistical 
analysis result showed p value was 0.035?  
 
7. The blatchford score is a non -endoscopy risk scoring system. Half of the study 
participtants in the presented study didn't have endoscopy. I will suggest authors to 
compare the predictive value between blatchford score and the parameters found by the 
investigators.  
 
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.  
 
Unable to assess  
 
Are 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 further 
assessment in your commen ts to the editors.  
 
I am abl e to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration 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 this 
manuscript, 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.  
 
No 
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted o n the website along with the authors' 
responses. 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/ ). I under stand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
assistant