Reviewer ’s report  
 
Title: High -density lipoprotein cholesterol to low -density lipopro tein cholesterol ratio in early 
assessment of disease severity and outcome in patients with acute panc reatitis admitted to the 
ICU 
 
Version: 0 Date: 09 Nov 2019  
 
Reviewer: Zhihui Tong  
 
Reviewer's report:  
 
This is a well -organized study investigating the effects of HDL/LDL ratio in predicting the 
mortality of acute pancreatitis patients. Here is some advice on this manuscript:  
 
 
Minor:  
 
1.in the conclusion part, our results suggest that lower H/L ratios are independently associated 
with poor progression in patients with AP, maybe here "lower H/L ratio" should be "higher H/L 
ratio"?  
 
2.in table 4, the column title "LDL -C&lt;0.465" should be  "H/L ratio &lt;0.465".  
 
 
Major revision:  
 
1.as discussed in previous researches, as well as according to our observation in the clinical 
practice, the change in cholesterol levels is often associated with or be companied by the change 
in triglyceride (TG) le vels, especially in HTG origin AP patients, so we think it makes sense to 
rule out the effects of HTG on clinical outcomes in AP patients, as it is reported that HTG was 
strongly and independently associated with the disease severity, and the occurrence of  organ 
failures in AP patients.  
 
2.When we talk about the early assessment of disease severity and clinical outcomes of AP 
patients, we do not think mortality is an indicator "early enough" for AP patients' stratification in 
the ICU, we recommend the author s focus more on the organ failure, especially the occurrence 
of persistent organ failure in AP patients and the predictive values of H/L ratio in it. Organ 
failure is the most important determinant for outcomes in AP patients and often takes place in the 
early stage.  
 
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 co ntrols 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 manuscript or would you reco mmend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require 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:  
 
Acceptable  
 
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 financia lly 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 organiza tion 
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.  
 
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 b e included 
on my report to the authors and, if the manuscript is accepted f or 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 in cluded as confidential comments 
to the editors, which will not be pub lished.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: High -density lipoprotein cholesterol to low -density lipopro tein cholesterol ratio in early 
assessment of disease severity and outcome in patients with acute panc reatitis admitted to the 
ICU 
 
Version: 0 Date: 09 Nov 2019  
 
Reviewer: Zhihui Tong  
 
Reviewer's report:  
 
This is a well -organized study investigating the effects of HDL/LDL ratio in predicting the 
mortality of acute pancreatitis patients. Here is some advice on this manuscript:  
 
 
Minor:  
 
1.in the conclusion part, our results suggest that lower H/L ratios are independently associated 
with poor progression in patients with AP, maybe here "lower H/L ratio" should be "higher H/L 
ratio"?  
 
2.in table 4, the column title "LDL -C&lt;0.465" should be  "H/L ratio &lt;0.465".  
 
 
Major revision:  
 
1.as discussed in previous researches, as well as according to our observation in the clinical 
practice, the change in cholesterol levels is often associated with or be companied by the change 
in triglyceride (TG) le vels, especially in HTG origin AP patients, so we think it makes sense to 
rule out the effects of HTG on clinical outcomes in AP patients, as it is reported that HTG was 
strongly and independently associated with the disease severity, and the occurrence of  organ 
failures in AP patients.  
 
2.When we talk about the early assessment of disease severity and clinical outcomes of AP 
patients, we do not think mortality is an indicator "early enough" for AP patients' stratification in 
the ICU, we recommend the author s focus more on the organ failure, especially the occurrence 
of persistent organ failure in AP patients and the predictive values of H/L ratio in it. Organ 
failure is the most important determinant for outcomes in AP patients and often takes place in the 
early stage.  
 
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 co ntrols 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 manuscript or would you reco mmend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require 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:  
 
Acceptable  
 
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 financia lly 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 organiza tion 
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.  
 
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 b e included 
on my report to the authors and, if the manuscript is accepted f or 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 in cluded as confidential comments 
to the editors, which will not be pub lished.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: High -density lipoprotein cholesterol to low -density lipopro tein cholesterol ratio in early 
assessment of disease severity and outcome in patients with acute panc reatitis admitted to the 
ICU 
 
Version: 0 Date: 09 Nov 2019  
 
Reviewer: Zhihui Tong  
 
Reviewer's report:  
 
This is a well -organized study investigating the effects of HDL/LDL ratio in predicting the 
mortality of acute pancreatitis patients. Here is some advice on this manuscript:  
 
 
Minor:  
 
1.in the conclusion part, our results suggest that lower H/L ratios are independently associated 
with poor progression in patients with AP, maybe here "lower H/L ratio" should be "higher H/L 
ratio"?  
 
2.in table 4, the column title "LDL -C&lt;0.465" should be  "H/L ratio &lt;0.465".  
 
 
Major revision:  
 
1.as discussed in previous researches, as well as according to our observation in the clinical 
practice, the change in cholesterol levels is often associated with or be companied by the change 
in triglyceride (TG) le vels, especially in HTG origin AP patients, so we think it makes sense to 
rule out the effects of HTG on clinical outcomes in AP patients, as it is reported that HTG was 
strongly and independently associated with the disease severity, and the occurrence of  organ 
failures in AP patients.  
 
2.When we talk about the early assessment of disease severity and clinical outcomes of AP 
patients, we do not think mortality is an indicator "early enough" for AP patients' stratification in 
the ICU, we recommend the author s focus more on the organ failure, especially the occurrence 
of persistent organ failure in AP patients and the predictive values of H/L ratio in it. Organ 
failure is the most important determinant for outcomes in AP patients and often takes place in the 
early stage.  
 
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 co ntrols 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 manuscript or would you reco mmend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require 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:  
 
Acceptable  
 
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 financia lly 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 organiza tion 
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.  
 
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 b e included 
on my report to the authors and, if the manuscript is accepted f or 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 in cluded as confidential comments 
to the editors, which will not be pub lished.  
 
I agree to the open peer review policy of the journal  
assistant