Title: Scoring System for Predicting 90-Day Mortality of In-hospital Liver Cirrhosis Patients
at Cipto Mangunkusumo Hospital
Version: 1 Date: 11 Dec 2022
Reviewer's report:
This was a single center, prospective, observational study on 116 patients with decompensated
cirrhosis who were hospitalized for an acute complication of their disease. The Authors followed
them up for 90 days after hospitalization, and created a score aimed at predicting survival.
Notably, 90-d mortality was very high (42%) and the patients who had both leucocyte count
>12.000, MELD>14 and CHILD Pugh C had a 90d mortality risk of 94%.
The aim of the study is not novel, since many scores (based both on biochemical and clinical
characteristics) have been proposed to assess and stratify prognosis in patients with cirrhosis.
Moreover, the proposed score has not been validated in other cohorts.
Major comments:
- Granular data about etiology of liver disease should be provided. “Non B non C” etiology
is quite confusing. How many patients had alcohol as first etiology? How many metabolic
diseases?
- Granular data about cause of first hospitalization, length of stay, causes of death are missed
and should be provided
- In the last decade, definitions as acute-on-chronic liver failure and acute decompensation have
been proposed by large Consortia to stratify prognosis of patients with cirrhosis.  For instance,
several studies (e.g., Trebicka et al 10.1016/j.jhep.2020.06.013) explored short-term prognosis
of patients with acute decompensation after their hospital discharge.
- Notably, the abovementioned Consortia considered in their scores not only biochemical, but
also clinical parameters (e.g., MAP, ventilation …) in order to predict patient survival. Why the
Authors decided to use only biochemical parameters?
- Did the patients have any comorbidity?
- How many patients were evaluated for liver transplantation?
- How many patients were considered for TIPSS after variceal bleeding?
- How many patients were hospitalized within 30 d?
- I do not agree with the Authors when they said that prognosis of patients with cirrhosis admitted
in ICU is always dismal. Several papers showed that ICU is the appropriate setting for ACLF
(II-III) patients since they can recovery after adequate intensive treatment (or can undergo LT)
Minor comments
- A significant proportion of patients (n. 32) was lost to follow-up, even in a relatively short
interval time (90 days). These patients did not return to the Hospital and cannot be contacted.
- Table 1. All subjects n=116 instead of n. 66
Title: Scoring System for Predicting 90-Day Mortality of In-hospital Liver Cirrhosis Patients
at Cipto Mangunkusumo Hospital
Version: 1 Date: 11 Dec 2022
Reviewer's report:
This was a single center, prospective, observational study on 116 patients with decompensated
cirrhosis who were hospitalized for an acute complication of their disease. The Authors followed
them up for 90 days after hospitalization, and created a score aimed at predicting survival.
Notably, 90-d mortality was very high (42%) and the patients who had both leucocyte count
>12.000, MELD>14 and CHILD Pugh C had a 90d mortality risk of 94%.
The aim of the study is not novel, since many scores (based both on biochemical and clinical
characteristics) have been proposed to assess and stratify prognosis in patients with cirrhosis.
Moreover, the proposed score has not been validated in other cohorts.
Major comments:
- Granular data about etiology of liver disease should be provided. “Non B non C” etiology
is quite confusing. How many patients had alcohol as first etiology? How many metabolic
diseases?
- Granular data about cause of first hospitalization, length of stay, causes of death are missed
and should be provided
- In the last decade, definitions as acute-on-chronic liver failure and acute decompensation have
been proposed by large Consortia to stratify prognosis of patients with cirrhosis.  For instance,
several studies (e.g., Trebicka et al 10.1016/j.jhep.2020.06.013) explored short-term prognosis
of patients with acute decompensation after their hospital discharge.
- Notably, the abovementioned Consortia considered in their scores not only biochemical, but
also clinical parameters (e.g., MAP, ventilation …) in order to predict patient survival. Why the
Authors decided to use only biochemical parameters?
- Did the patients have any comorbidity?
- How many patients were evaluated for liver transplantation?
- How many patients were considered for TIPSS after variceal bleeding?
- How many patients were hospitalized within 30 d?
- I do not agree with the Authors when they said that prognosis of patients with cirrhosis admitted
in ICU is always dismal. Several papers showed that ICU is the appropriate setting for ACLF
(II-III) patients since they can recovery after adequate intensive treatment (or can undergo LT)
Minor comments
- A significant proportion of patients (n. 32) was lost to follow-up, even in a relatively short
interval time (90 days). These patients did not return to the Hospital and cannot be contacted.
- Table 1. All subjects n=116 instead of n. 66
Please review this paper.
user
Title: Scoring System for Predicting 90-Day Mortality of In-hospital Liver Cirrhosis Patients
at Cipto Mangunkusumo Hospital
Version: 1 Date: 11 Dec 2022
Reviewer's report:
This was a single center, prospective, observational study on 116 patients with decompensated
cirrhosis who were hospitalized for an acute complication of their disease. The Authors followed
them up for 90 days after hospitalization, and created a score aimed at predicting survival.
Notably, 90-d mortality was very high (42%) and the patients who had both leucocyte count
>12.000, MELD>14 and CHILD Pugh C had a 90d mortality risk of 94%.
The aim of the study is not novel, since many scores (based both on biochemical and clinical
characteristics) have been proposed to assess and stratify prognosis in patients with cirrhosis.
Moreover, the proposed score has not been validated in other cohorts.
Major comments:
- Granular data about etiology of liver disease should be provided. “Non B non C” etiology
is quite confusing. How many patients had alcohol as first etiology? How many metabolic
diseases?
- Granular data about cause of first hospitalization, length of stay, causes of death are missed
and should be provided
- In the last decade, definitions as acute-on-chronic liver failure and acute decompensation have
been proposed by large Consortia to stratify prognosis of patients with cirrhosis.  For instance,
several studies (e.g., Trebicka et al 10.1016/j.jhep.2020.06.013) explored short-term prognosis
of patients with acute decompensation after their hospital discharge.
- Notably, the abovementioned Consortia considered in their scores not only biochemical, but
also clinical parameters (e.g., MAP, ventilation …) in order to predict patient survival. Why the
Authors decided to use only biochemical parameters?
- Did the patients have any comorbidity?
- How many patients were evaluated for liver transplantation?
- How many patients were considered for TIPSS after variceal bleeding?
- How many patients were hospitalized within 30 d?
- I do not agree with the Authors when they said that prognosis of patients with cirrhosis admitted
in ICU is always dismal. Several papers showed that ICU is the appropriate setting for ACLF
(II-III) patients since they can recovery after adequate intensive treatment (or can undergo LT)
Minor comments
- A significant proportion of patients (n. 32) was lost to follow-up, even in a relatively short
interval time (90 days). These patients did not return to the Hospital and cannot be contacted.
- Table 1. All subjects n=116 instead of n. 66
assistant