Reviewer's report
Title:The galactose elimination capacity and mortality in 781 Danish patients
with newly-diagnosed liver cirrhosis: a cohort study
Version: 1Date:22 December 2008
Reviewer: Giulio Marchesini
Reviewer's report:
Jepsen et al report a large experience on GEC as predictive of short- and
long-term survival in newly-diagnosed cirrhosis. In their experience based on 781
cases having GEC determination within 90 days from diagnosis, GEC was
significantly associated with mortality, and the association does not change much
after correction for age and comorbidities.
There are however a few issues that should be discussed in more details.
Major compulsory revisions
1. The manuscript is extremely concise and lacks any statistical analysis. From
the figure the reader has the impression that there is a continuum between GEC
and survival, after lowess smoothing, but it is also evident that survival is
scarcely affected by GEC in the range above 1.5-1.75 mmol/L, if not at all. The
confidence interval of the regression line is not plotted, and I can hardly guess
that the line deviates from a horizontal line. This is clinically sound, and should
be tested by proper statistical methods.
2. Apparently, only all-cause mortality was considered. This is very robust
outcome, but GEC might be more predictive of liver-related mortality. Were this
piece of information available, it should be presented in the manuscript.
3. Charlson’s index provides a quantitative estimate of comorbidities, by
summing up the scores of diseases in different organs, having different scores. It
is not clear in the manuscript if the presence/absence of comorbidities was
considered (this is my impression), or data were adjusted for the final score. This
may make a large difference in the final outcome.
Minor essential revisions
1. Apparently, only all-cause mortality was considered. This is very robust
outcome, but GEC might be more predictive of liver-related mortality. Were this
piece of information available, it should be presented in the manuscript.
Discretionary revisions
1. The physiologic meaning and the clinical robustness of GEC are out of
discussion. Its limited use is not related to technical difficulties, but to the lack of
evidence of a clear-cut superiority when compared to standard liver tests. This
may be due to uncertainty in the measurement (Confidence Interval of the
regression line), as well as to the confounding effects of complications. From a
clinical point of view, we need to know whether GEC behaves significantly better
than routine tests (albumin, prothrombin) in clinical prediction. It is a pity that this
information is not presented in the manuscript. This limits the clinical significance
of the study, and should be tested or discussed.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:The galactose elimination capacity and mortality in 781 Danish patients
with newly-diagnosed liver cirrhosis: a cohort study
Version: 1Date:22 December 2008
Reviewer: Giulio Marchesini
Reviewer's report:
Jepsen et al report a large experience on GEC as predictive of short- and
long-term survival in newly-diagnosed cirrhosis. In their experience based on 781
cases having GEC determination within 90 days from diagnosis, GEC was
significantly associated with mortality, and the association does not change much
after correction for age and comorbidities.
There are however a few issues that should be discussed in more details.
Major compulsory revisions
1. The manuscript is extremely concise and lacks any statistical analysis. From
the figure the reader has the impression that there is a continuum between GEC
and survival, after lowess smoothing, but it is also evident that survival is
scarcely affected by GEC in the range above 1.5-1.75 mmol/L, if not at all. The
confidence interval of the regression line is not plotted, and I can hardly guess
that the line deviates from a horizontal line. This is clinically sound, and should
be tested by proper statistical methods.
2. Apparently, only all-cause mortality was considered. This is very robust
outcome, but GEC might be more predictive of liver-related mortality. Were this
piece of information available, it should be presented in the manuscript.
3. Charlson’s index provides a quantitative estimate of comorbidities, by
summing up the scores of diseases in different organs, having different scores. It
is not clear in the manuscript if the presence/absence of comorbidities was
considered (this is my impression), or data were adjusted for the final score. This
may make a large difference in the final outcome.
Minor essential revisions
1. Apparently, only all-cause mortality was considered. This is very robust
outcome, but GEC might be more predictive of liver-related mortality. Were this
piece of information available, it should be presented in the manuscript.
Discretionary revisions
1. The physiologic meaning and the clinical robustness of GEC are out of
discussion. Its limited use is not related to technical difficulties, but to the lack of
evidence of a clear-cut superiority when compared to standard liver tests. This
may be due to uncertainty in the measurement (Confidence Interval of the
regression line), as well as to the confounding effects of complications. From a
clinical point of view, we need to know whether GEC behaves significantly better
than routine tests (albumin, prothrombin) in clinical prediction. It is a pity that this
information is not presented in the manuscript. This limits the clinical significance
of the study, and should be tested or discussed.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:The galactose elimination capacity and mortality in 781 Danish patients
with newly-diagnosed liver cirrhosis: a cohort study
Version: 1Date:22 December 2008
Reviewer: Giulio Marchesini
Reviewer's report:
Jepsen et al report a large experience on GEC as predictive of short- and
long-term survival in newly-diagnosed cirrhosis. In their experience based on 781
cases having GEC determination within 90 days from diagnosis, GEC was
significantly associated with mortality, and the association does not change much
after correction for age and comorbidities.
There are however a few issues that should be discussed in more details.
Major compulsory revisions
1. The manuscript is extremely concise and lacks any statistical analysis. From
the figure the reader has the impression that there is a continuum between GEC
and survival, after lowess smoothing, but it is also evident that survival is
scarcely affected by GEC in the range above 1.5-1.75 mmol/L, if not at all. The
confidence interval of the regression line is not plotted, and I can hardly guess
that the line deviates from a horizontal line. This is clinically sound, and should
be tested by proper statistical methods.
2. Apparently, only all-cause mortality was considered. This is very robust
outcome, but GEC might be more predictive of liver-related mortality. Were this
piece of information available, it should be presented in the manuscript.
3. Charlson’s index provides a quantitative estimate of comorbidities, by
summing up the scores of diseases in different organs, having different scores. It
is not clear in the manuscript if the presence/absence of comorbidities was
considered (this is my impression), or data were adjusted for the final score. This
may make a large difference in the final outcome.
Minor essential revisions
1. Apparently, only all-cause mortality was considered. This is very robust
outcome, but GEC might be more predictive of liver-related mortality. Were this
piece of information available, it should be presented in the manuscript.
Discretionary revisions
1. The physiologic meaning and the clinical robustness of GEC are out of
discussion. Its limited use is not related to technical difficulties, but to the lack of
evidence of a clear-cut superiority when compared to standard liver tests. This
may be due to uncertainty in the measurement (Confidence Interval of the
regression line), as well as to the confounding effects of complications. From a
clinical point of view, we need to know whether GEC behaves significantly better
than routine tests (albumin, prothrombin) in clinical prediction. It is a pity that this
information is not presented in the manuscript. This limits the clinical significance
of the study, and should be tested or discussed.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
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