Title: Predictive value of adipokines for the severity of acute pancreatitis: a meta-analysis
Version: 6 Date: 11 Sep 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is the Review of the manuscript titled ""Predictive value of
adipokines for the severity of acute pancreatitis: a meta-analysis"", where authors performed a
meta-analysis of already described cohorts of patients for circulating levels of leptin, visfatin,
adiponectin and resistin and their association with acute pancreatitis, especially its severe form
(SAP). Said meta-analysis is correctly executed, but it does not go further than confirming the
results of previous study of Yang et al. 2022. Authors added leptin, visfatin and adiponectin
in to analysis, with no significant findings. In my opinion, this paper should be framed in a
different way, with a stress on its confirmatory nature for resistin and justification of a choice
of L, V, A adipokines done in the Introduction, not in Discussion. The Discussion should be
reserved for talking about resisting and its possible role in AP - which should extend for much
more than one paragraph.  If authors to make a claim that resistin is more than biomarker,
but a potential therapeutic target, than this claim should be made in Discussion, with thorough
supporting argumentation. Alaso, all cytokines selected for study are well known biomarkers for
NAFLD, and NFLD is strong risk factor for AP and SAP. NAFLD as a risk factor intersection
with these biomarkers should at least be mentioned.
The authors have addressed the requested revisions of the previous reviewer(s) in full.
REQUESTED REVISIONS:
The revisions are listed in general part of this review. In addition, language should be improved.
below are examples of corrected sentences (but more proofreads are needed) 1. Calculation of
the pooled SMD was performed using a random effects model. 2. it may be possible in the future
to predict SAP by testing for the levels of resistin in conjunction with other indicators ... 3.
Standardized (not standartised) 4. parts of ABSTRACT:
Fifteen eligible studies included 1332 patients with acute pancreatitis (AP). Pooled analysis
showed that patients with SAP had significantly higher serum levels of resistin (SMD = 0.78,
95% CI:0.37 to 1.19, z = 3.75, P = 0.000). The differences in circulating leptin and adiponectin
levels between SAP and mild acute pancreatitis (MAP) patients were not significant (SMD =
0.30, 95% CI: -0.08 to 0.68, z = 1.53, P = 0.127 and SMD = 0.11, 95% CI: -0.17 to 0.40, z = 0.80,
P = 0.425, respectively). In patients with SAP, visfatin levels were not significantly different
from that in patients with MAP (SMD = 1.20, 95% CI: -0.48 to 2.88, z = 1.40, P = 0.162).
Conclusion Elevated levels of resistin are associated with the development of SAP. Resistin may
serve as biomarker for SAP and has promise as therapeutic target. 5. Acute pancreatitis (AP) is a
common gastroenterological condition, with approximately 80% of patients developing mild to
moderately severe disease (no organ failure >48 hours) and the rest progressing into severe acute
pancreatitis (SAP) [1]. The death rate of SAP is as high as 20%, therefore, early assessment
of severity in AP is crucial. Despite the large number of studies exploring early prediction of
AP severity [2,3], no ideal multifactorial scoring system and/or biochemical markers have been
identified for early assessment of AP severity [4].
In clinical studies, the components of metabolic syndrome were associated with the occurrence
and deterioration of AP [5,6]. In particular, obesity is an independent risk factor for the AP
morbidity and mortality [7-10].
Also please note: - the sentence below is NOT correct "" As it can only accommodate a restrict
number of adipocytes with limited expandability, fat begins to build up in areas outside the SAT
once the storage capacity is exceeded—a process known as ectopic fat accumulation, which
explains why fat accumulates in the viscera and forms VAT [11,12]. ""
Certain amounts of visceral adipose are normally present in the body. Therefore, this
compartment cannot be be referred as a simple toxic storage of overflow.. Please correct this"
Title: Predictive value of adipokines for the severity of acute pancreatitis: a meta-analysis
Version: 6 Date: 11 Sep 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is the Review of the manuscript titled ""Predictive value of
adipokines for the severity of acute pancreatitis: a meta-analysis"", where authors performed a
meta-analysis of already described cohorts of patients for circulating levels of leptin, visfatin,
adiponectin and resistin and their association with acute pancreatitis, especially its severe form
(SAP). Said meta-analysis is correctly executed, but it does not go further than confirming the
results of previous study of Yang et al. 2022. Authors added leptin, visfatin and adiponectin
in to analysis, with no significant findings. In my opinion, this paper should be framed in a
different way, with a stress on its confirmatory nature for resistin and justification of a choice
of L, V, A adipokines done in the Introduction, not in Discussion. The Discussion should be
reserved for talking about resisting and its possible role in AP - which should extend for much
more than one paragraph.  If authors to make a claim that resistin is more than biomarker,
but a potential therapeutic target, than this claim should be made in Discussion, with thorough
supporting argumentation. Alaso, all cytokines selected for study are well known biomarkers for
NAFLD, and NFLD is strong risk factor for AP and SAP. NAFLD as a risk factor intersection
with these biomarkers should at least be mentioned.
The authors have addressed the requested revisions of the previous reviewer(s) in full.
REQUESTED REVISIONS:
The revisions are listed in general part of this review. In addition, language should be improved.
below are examples of corrected sentences (but more proofreads are needed) 1. Calculation of
the pooled SMD was performed using a random effects model. 2. it may be possible in the future
to predict SAP by testing for the levels of resistin in conjunction with other indicators ... 3.
Standardized (not standartised) 4. parts of ABSTRACT:
Fifteen eligible studies included 1332 patients with acute pancreatitis (AP). Pooled analysis
showed that patients with SAP had significantly higher serum levels of resistin (SMD = 0.78,
95% CI:0.37 to 1.19, z = 3.75, P = 0.000). The differences in circulating leptin and adiponectin
levels between SAP and mild acute pancreatitis (MAP) patients were not significant (SMD =
0.30, 95% CI: -0.08 to 0.68, z = 1.53, P = 0.127 and SMD = 0.11, 95% CI: -0.17 to 0.40, z = 0.80,
P = 0.425, respectively). In patients with SAP, visfatin levels were not significantly different
from that in patients with MAP (SMD = 1.20, 95% CI: -0.48 to 2.88, z = 1.40, P = 0.162).
Conclusion Elevated levels of resistin are associated with the development of SAP. Resistin may
serve as biomarker for SAP and has promise as therapeutic target. 5. Acute pancreatitis (AP) is a
common gastroenterological condition, with approximately 80% of patients developing mild to
moderately severe disease (no organ failure >48 hours) and the rest progressing into severe acute
pancreatitis (SAP) [1]. The death rate of SAP is as high as 20%, therefore, early assessment
of severity in AP is crucial. Despite the large number of studies exploring early prediction of
AP severity [2,3], no ideal multifactorial scoring system and/or biochemical markers have been
identified for early assessment of AP severity [4].
In clinical studies, the components of metabolic syndrome were associated with the occurrence
and deterioration of AP [5,6]. In particular, obesity is an independent risk factor for the AP
morbidity and mortality [7-10].
Also please note: - the sentence below is NOT correct "" As it can only accommodate a restrict
number of adipocytes with limited expandability, fat begins to build up in areas outside the SAT
once the storage capacity is exceeded—a process known as ectopic fat accumulation, which
explains why fat accumulates in the viscera and forms VAT [11,12]. ""
Certain amounts of visceral adipose are normally present in the body. Therefore, this
compartment cannot be be referred as a simple toxic storage of overflow.. Please correct this"
Please review this paper.
user
Title: Predictive value of adipokines for the severity of acute pancreatitis: a meta-analysis
Version: 6 Date: 11 Sep 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is the Review of the manuscript titled ""Predictive value of
adipokines for the severity of acute pancreatitis: a meta-analysis"", where authors performed a
meta-analysis of already described cohorts of patients for circulating levels of leptin, visfatin,
adiponectin and resistin and their association with acute pancreatitis, especially its severe form
(SAP). Said meta-analysis is correctly executed, but it does not go further than confirming the
results of previous study of Yang et al. 2022. Authors added leptin, visfatin and adiponectin
in to analysis, with no significant findings. In my opinion, this paper should be framed in a
different way, with a stress on its confirmatory nature for resistin and justification of a choice
of L, V, A adipokines done in the Introduction, not in Discussion. The Discussion should be
reserved for talking about resisting and its possible role in AP - which should extend for much
more than one paragraph.  If authors to make a claim that resistin is more than biomarker,
but a potential therapeutic target, than this claim should be made in Discussion, with thorough
supporting argumentation. Alaso, all cytokines selected for study are well known biomarkers for
NAFLD, and NFLD is strong risk factor for AP and SAP. NAFLD as a risk factor intersection
with these biomarkers should at least be mentioned.
The authors have addressed the requested revisions of the previous reviewer(s) in full.
REQUESTED REVISIONS:
The revisions are listed in general part of this review. In addition, language should be improved.
below are examples of corrected sentences (but more proofreads are needed) 1. Calculation of
the pooled SMD was performed using a random effects model. 2. it may be possible in the future
to predict SAP by testing for the levels of resistin in conjunction with other indicators ... 3.
Standardized (not standartised) 4. parts of ABSTRACT:
Fifteen eligible studies included 1332 patients with acute pancreatitis (AP). Pooled analysis
showed that patients with SAP had significantly higher serum levels of resistin (SMD = 0.78,
95% CI:0.37 to 1.19, z = 3.75, P = 0.000). The differences in circulating leptin and adiponectin
levels between SAP and mild acute pancreatitis (MAP) patients were not significant (SMD =
0.30, 95% CI: -0.08 to 0.68, z = 1.53, P = 0.127 and SMD = 0.11, 95% CI: -0.17 to 0.40, z = 0.80,
P = 0.425, respectively). In patients with SAP, visfatin levels were not significantly different
from that in patients with MAP (SMD = 1.20, 95% CI: -0.48 to 2.88, z = 1.40, P = 0.162).
Conclusion Elevated levels of resistin are associated with the development of SAP. Resistin may
serve as biomarker for SAP and has promise as therapeutic target. 5. Acute pancreatitis (AP) is a
common gastroenterological condition, with approximately 80% of patients developing mild to
moderately severe disease (no organ failure >48 hours) and the rest progressing into severe acute
pancreatitis (SAP) [1]. The death rate of SAP is as high as 20%, therefore, early assessment
of severity in AP is crucial. Despite the large number of studies exploring early prediction of
AP severity [2,3], no ideal multifactorial scoring system and/or biochemical markers have been
identified for early assessment of AP severity [4].
In clinical studies, the components of metabolic syndrome were associated with the occurrence
and deterioration of AP [5,6]. In particular, obesity is an independent risk factor for the AP
morbidity and mortality [7-10].
Also please note: - the sentence below is NOT correct "" As it can only accommodate a restrict
number of adipocytes with limited expandability, fat begins to build up in areas outside the SAT
once the storage capacity is exceeded—a process known as ectopic fat accumulation, which
explains why fat accumulates in the viscera and forms VAT [11,12]. ""
Certain amounts of visceral adipose are normally present in the body. Therefore, this
compartment cannot be be referred as a simple toxic storage of overflow.. Please correct this"
assistant