Reviewer ’s report  
Title: A comparison of pyogenic liver abscess in patients with or wi thout diabetes: A 
retrospective study of 246 cases  
 
Version: 0 Date: 18 Jun 2018  
 
Reviewer: Abhishek Agni hotri  
 
Reviewer's report:  
The authors have tried to better characterize liver abscesses seen in the diabetic population. With 
increasing incidence of type 2 Diabetes, we are seeing increasing number of patients with 
Diabetes and PLAs. As the authors mentioned, the largest limitatio n of such a study is its 
retrospective nature and multiple confounding variables. First and foremost, the authors should 
cite a similar study from similar geographical region done by Tian,et al. (Clin Microbiol Infect. 
2012 Sep;18(9):E314 -30.). The methods  are appropriate but there are some important 
considerations. As authors point out, patients with DM, had less incidence of previous surgeries, 
this likely explains why solitary abscesses were more common in Diabetics. It is also important 
to find out what  kind of surgeries or procedures had been done prior, eg. TACE and splenectomy 
have been linked with certain PLAs. It is also worthwhile to study glycemic control of diabetic 
patients, what was the HbA1c of diabetes patients. It is not surprising that Diab etics were older 
and had higher incidence of hypertension given the fact that its incidence is lower in younger age 
group. It will also be interesting to see how many patients required ICU stay or presented with 
severe sepsis, as that would have a bearing on choosing combination antibiotic herapy for broad 
coverage. Overall, I think this is an area of further investigation. With better identification of 
confounding variables, the quality of this study will be improved.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further 
assessment in your comments to the editors.  
I am able 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 re lating 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.  
 
I declare that I have no competing interests.  
 
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 on 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 understand that any comments 
which I do not wish to be included in my named report can be included as confidenti al comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
Title: A comparison of pyogenic liver abscess in patients with or wi thout diabetes: A 
retrospective study of 246 cases  
 
Version: 0 Date: 18 Jun 2018  
 
Reviewer: Abhishek Agni hotri  
 
Reviewer's report:  
The authors have tried to better characterize liver abscesses seen in the diabetic population. With 
increasing incidence of type 2 Diabetes, we are seeing increasing number of patients with 
Diabetes and PLAs. As the authors mentioned, the largest limitatio n of such a study is its 
retrospective nature and multiple confounding variables. First and foremost, the authors should 
cite a similar study from similar geographical region done by Tian,et al. (Clin Microbiol Infect. 
2012 Sep;18(9):E314 -30.). The methods  are appropriate but there are some important 
considerations. As authors point out, patients with DM, had less incidence of previous surgeries, 
this likely explains why solitary abscesses were more common in Diabetics. It is also important 
to find out what  kind of surgeries or procedures had been done prior, eg. TACE and splenectomy 
have been linked with certain PLAs. It is also worthwhile to study glycemic control of diabetic 
patients, what was the HbA1c of diabetes patients. It is not surprising that Diab etics were older 
and had higher incidence of hypertension given the fact that its incidence is lower in younger age 
group. It will also be interesting to see how many patients required ICU stay or presented with 
severe sepsis, as that would have a bearing on choosing combination antibiotic herapy for broad 
coverage. Overall, I think this is an area of further investigation. With better identification of 
confounding variables, the quality of this study will be improved.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further 
assessment in your comments to the editors.  
I am able 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 re lating 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.  
 
I declare that I have no competing interests.  
 
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 on 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 understand that any comments 
which I do not wish to be included in my named report can be included as confidenti al 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: A comparison of pyogenic liver abscess in patients with or wi thout diabetes: A 
retrospective study of 246 cases  
 
Version: 0 Date: 18 Jun 2018  
 
Reviewer: Abhishek Agni hotri  
 
Reviewer's report:  
The authors have tried to better characterize liver abscesses seen in the diabetic population. With 
increasing incidence of type 2 Diabetes, we are seeing increasing number of patients with 
Diabetes and PLAs. As the authors mentioned, the largest limitatio n of such a study is its 
retrospective nature and multiple confounding variables. First and foremost, the authors should 
cite a similar study from similar geographical region done by Tian,et al. (Clin Microbiol Infect. 
2012 Sep;18(9):E314 -30.). The methods  are appropriate but there are some important 
considerations. As authors point out, patients with DM, had less incidence of previous surgeries, 
this likely explains why solitary abscesses were more common in Diabetics. It is also important 
to find out what  kind of surgeries or procedures had been done prior, eg. TACE and splenectomy 
have been linked with certain PLAs. It is also worthwhile to study glycemic control of diabetic 
patients, what was the HbA1c of diabetes patients. It is not surprising that Diab etics were older 
and had higher incidence of hypertension given the fact that its incidence is lower in younger age 
group. It will also be interesting to see how many patients required ICU stay or presented with 
severe sepsis, as that would have a bearing on choosing combination antibiotic herapy for broad 
coverage. Overall, I think this is an area of further investigation. With better identification of 
confounding variables, the quality of this study will be improved.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further 
assessment in your comments to the editors.  
I am able 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 re lating 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.  
 
I declare that I have no competing interests.  
 
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 on 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 understand that any comments 
which I do not wish to be included in my named report can be included as confidenti al comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant