Reviewer’ s report
Title: Evaluation of NAFLD and fibrosis in obese patients –a comparison of histological and
clinical scoring systems
Version: 1Date: 04 Jun 2020
Reviewer: Philipp Schwabl
Reviewer's report:
With interest I read the revised manuscript "Evaluation of NAFLD and fibrosis in obese patients -
a comparison of histological and clinical scoring systems" by Dr. Schmitz et. al. While the authorshave improved the paper, there are still some points which should be addressed:
MAJOR:
1) Your answer to minor comment #1 ("serum parameters were recorded in the period of 14 daysprior to surgery") is in contrast to the statement in the methods on page 7 ("preoperative bloodsamples were collected following overnight fasting"), which suggests that blood sampling wasperformed preoperatively on the day of surgery (I wouldn't expect that the current statement in themethods covers a time-frame of up to 14 days). Since many scores rely on blood parameters and asyou state "laboratory values may differ even from one day to the next" it is of utmost importanceto unevocally describe how, when and under which conditions blood was taken to calculate therespective scores. In this context, also the answer to minor comment #3 "LiMax test wasperformed on the same date as recording of serum parameters to ensure comparability, i.e. duringthe last two weeks prior to surgery" shows inconsistencies, especially since "In LiMAx test, mostimportant factor is that the test has to be made with a fasting patient.", which is not specified in the
methods (same date does not automatically imply that the patients has been fasted). Please specify
in the methods how, when and under which conditions Limax testing was performed. In case acertain percentage of patients was not fasted during Limax testing, please report this, since thatsheds a different light on the discussion that "APRI index proves more useful in clinical routinethan the more complex and more expensive LiMAx".
MINOR:
1) Thank you for defining the diabetes diagnosis criteria. This is now clear to me. However inorder to make it also clear for the future readers, please also include this statement in the methods.2) The Table 2 now gives a nice overview, however there is at least one mistake as for APRI/NASsensitivity and specificity values are not the same as written in the text. Please carefully check thewhole table! Moreover, I recommend to use clearer headings (than NAS, SAF-Score and Fibrosis)so that readers can also understand the table and what exactly the cut-offs distinguish without thenecessity to read the manuscript.
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.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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.
I declare that I have no competing interests
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.
Reviewer’ s report
Title: Evaluation of NAFLD and fibrosis in obese patients –a comparison of histological and
clinical scoring systems
Version: 1Date: 04 Jun 2020
Reviewer: Philipp Schwabl
Reviewer's report:
With interest I read the revised manuscript "Evaluation of NAFLD and fibrosis in obese patients -
a comparison of histological and clinical scoring systems" by Dr. Schmitz et. al. While the authorshave improved the paper, there are still some points which should be addressed:
MAJOR:
1) Your answer to minor comment #1 ("serum parameters were recorded in the period of 14 daysprior to surgery") is in contrast to the statement in the methods on page 7 ("preoperative bloodsamples were collected following overnight fasting"), which suggests that blood sampling wasperformed preoperatively on the day of surgery (I wouldn't expect that the current statement in themethods covers a time-frame of up to 14 days). Since many scores rely on blood parameters and asyou state "laboratory values may differ even from one day to the next" it is of utmost importanceto unevocally describe how, when and under which conditions blood was taken to calculate therespective scores. In this context, also the answer to minor comment #3 "LiMax test wasperformed on the same date as recording of serum parameters to ensure comparability, i.e. duringthe last two weeks prior to surgery" shows inconsistencies, especially since "In LiMAx test, mostimportant factor is that the test has to be made with a fasting patient.", which is not specified in the
methods (same date does not automatically imply that the patients has been fasted). Please specify
in the methods how, when and under which conditions Limax testing was performed. In case acertain percentage of patients was not fasted during Limax testing, please report this, since thatsheds a different light on the discussion that "APRI index proves more useful in clinical routinethan the more complex and more expensive LiMAx".
MINOR:
1) Thank you for defining the diabetes diagnosis criteria. This is now clear to me. However inorder to make it also clear for the future readers, please also include this statement in the methods.2) The Table 2 now gives a nice overview, however there is at least one mistake as for APRI/NASsensitivity and specificity values are not the same as written in the text. Please carefully check thewhole table! Moreover, I recommend to use clearer headings (than NAS, SAF-Score and Fibrosis)so that readers can also understand the table and what exactly the cut-offs distinguish without thenecessity to read the manuscript.
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.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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.
I declare that I have no competing interests
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.
Please review this paper.
user
Reviewer’ s report
Title: Evaluation of NAFLD and fibrosis in obese patients –a comparison of histological and
clinical scoring systems
Version: 1Date: 04 Jun 2020
Reviewer: Philipp Schwabl
Reviewer's report:
With interest I read the revised manuscript "Evaluation of NAFLD and fibrosis in obese patients -
a comparison of histological and clinical scoring systems" by Dr. Schmitz et. al. While the authorshave improved the paper, there are still some points which should be addressed:
MAJOR:
1) Your answer to minor comment #1 ("serum parameters were recorded in the period of 14 daysprior to surgery") is in contrast to the statement in the methods on page 7 ("preoperative bloodsamples were collected following overnight fasting"), which suggests that blood sampling wasperformed preoperatively on the day of surgery (I wouldn't expect that the current statement in themethods covers a time-frame of up to 14 days). Since many scores rely on blood parameters and asyou state "laboratory values may differ even from one day to the next" it is of utmost importanceto unevocally describe how, when and under which conditions blood was taken to calculate therespective scores. In this context, also the answer to minor comment #3 "LiMax test wasperformed on the same date as recording of serum parameters to ensure comparability, i.e. duringthe last two weeks prior to surgery" shows inconsistencies, especially since "In LiMAx test, mostimportant factor is that the test has to be made with a fasting patient.", which is not specified in the
methods (same date does not automatically imply that the patients has been fasted). Please specify
in the methods how, when and under which conditions Limax testing was performed. In case acertain percentage of patients was not fasted during Limax testing, please report this, since thatsheds a different light on the discussion that "APRI index proves more useful in clinical routinethan the more complex and more expensive LiMAx".
MINOR:
1) Thank you for defining the diabetes diagnosis criteria. This is now clear to me. However inorder to make it also clear for the future readers, please also include this statement in the methods.2) The Table 2 now gives a nice overview, however there is at least one mistake as for APRI/NASsensitivity and specificity values are not the same as written in the text. Please carefully check thewhole table! Moreover, I recommend to use clearer headings (than NAS, SAF-Score and Fibrosis)so that readers can also understand the table and what exactly the cut-offs distinguish without thenecessity to read the manuscript.
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.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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.
I declare that I have no competing interests
Reviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.
assistant