Title: Differences in clinical characteristics and liver injury between patients diagnosed with the
Omicron subvariant BA.5.2 and the prototype of SARS-CoV-2: A single center retrospective
study
Version: 1 Date: 26 Jun 2023
Reviewer's report:
The authors compared Omicron and SARS-Cov2 and reported in detail on clinical presentation,
respiratory complications, and blood tests for liver function. A comparison between the 2 groups
of blood tests showed that Omicron was significantly milder, and multivariate analysis was
performed regarding the factors presenting with abnormal liver function, and elevated CRP was
extracted.
The biggest problem is that it is not clear whether this analysis can evaluate the true liver
dysfunction. As authors reported in this article, SARDs-CoV2 causes systemic inflammation,
but in this report it is not possible to evaluate whether there is true liver damage. Coronaviruses
cause inflammation in blood vessels throughout the body and can affect levels of FDP, Dimeri
and PT. It is also well known that systemic tissue damage is reflected in an increase in
transaminases and a decrease levels of Alb. And these changes of parameter do not automatically
indicate liver damage. As far as the analysis results of this time are concerned, it is highly likely
that the status of liver damage has not been fully evaluated. If there is hepatosplenomegaly on
physical examination, the presence of hepatomegaly on image evaluation, and if hepatitis is
present, for example, the presence of periportal edema, and if actual pathological evaluation
such as liver biopsy can be added, the presence of liver damage can be further evaluated.
In this report, liver function test is checked in many patients but is not shown why these
omicron showed mild liver dysfunction compared with prototype. As previous studies have
reported, SARD-CoV-2 has systemic inflammatory disease, accompanied by hematological
abnormalities' including PT-INR, Ddier, and low-Alb.  How hoes authors show Is it really liver-
specific damage? If authors have evaluated liver biopsies, these parameters would strengthen
evidence, but at this point, we cannot understand why these omicron is milder phenotype, or
even liver-specific damage by omicron, or SARS-Cov-2.
Title: Differences in clinical characteristics and liver injury between patients diagnosed with the
Omicron subvariant BA.5.2 and the prototype of SARS-CoV-2: A single center retrospective
study
Version: 1 Date: 26 Jun 2023
Reviewer's report:
The authors compared Omicron and SARS-Cov2 and reported in detail on clinical presentation,
respiratory complications, and blood tests for liver function. A comparison between the 2 groups
of blood tests showed that Omicron was significantly milder, and multivariate analysis was
performed regarding the factors presenting with abnormal liver function, and elevated CRP was
extracted.
The biggest problem is that it is not clear whether this analysis can evaluate the true liver
dysfunction. As authors reported in this article, SARDs-CoV2 causes systemic inflammation,
but in this report it is not possible to evaluate whether there is true liver damage. Coronaviruses
cause inflammation in blood vessels throughout the body and can affect levels of FDP, Dimeri
and PT. It is also well known that systemic tissue damage is reflected in an increase in
transaminases and a decrease levels of Alb. And these changes of parameter do not automatically
indicate liver damage. As far as the analysis results of this time are concerned, it is highly likely
that the status of liver damage has not been fully evaluated. If there is hepatosplenomegaly on
physical examination, the presence of hepatomegaly on image evaluation, and if hepatitis is
present, for example, the presence of periportal edema, and if actual pathological evaluation
such as liver biopsy can be added, the presence of liver damage can be further evaluated.
In this report, liver function test is checked in many patients but is not shown why these
omicron showed mild liver dysfunction compared with prototype. As previous studies have
reported, SARD-CoV-2 has systemic inflammatory disease, accompanied by hematological
abnormalities' including PT-INR, Ddier, and low-Alb.  How hoes authors show Is it really liver-
specific damage? If authors have evaluated liver biopsies, these parameters would strengthen
evidence, but at this point, we cannot understand why these omicron is milder phenotype, or
even liver-specific damage by omicron, or SARS-Cov-2.
Please review this paper.
user
Title: Differences in clinical characteristics and liver injury between patients diagnosed with the
Omicron subvariant BA.5.2 and the prototype of SARS-CoV-2: A single center retrospective
study
Version: 1 Date: 26 Jun 2023
Reviewer's report:
The authors compared Omicron and SARS-Cov2 and reported in detail on clinical presentation,
respiratory complications, and blood tests for liver function. A comparison between the 2 groups
of blood tests showed that Omicron was significantly milder, and multivariate analysis was
performed regarding the factors presenting with abnormal liver function, and elevated CRP was
extracted.
The biggest problem is that it is not clear whether this analysis can evaluate the true liver
dysfunction. As authors reported in this article, SARDs-CoV2 causes systemic inflammation,
but in this report it is not possible to evaluate whether there is true liver damage. Coronaviruses
cause inflammation in blood vessels throughout the body and can affect levels of FDP, Dimeri
and PT. It is also well known that systemic tissue damage is reflected in an increase in
transaminases and a decrease levels of Alb. And these changes of parameter do not automatically
indicate liver damage. As far as the analysis results of this time are concerned, it is highly likely
that the status of liver damage has not been fully evaluated. If there is hepatosplenomegaly on
physical examination, the presence of hepatomegaly on image evaluation, and if hepatitis is
present, for example, the presence of periportal edema, and if actual pathological evaluation
such as liver biopsy can be added, the presence of liver damage can be further evaluated.
In this report, liver function test is checked in many patients but is not shown why these
omicron showed mild liver dysfunction compared with prototype. As previous studies have
reported, SARD-CoV-2 has systemic inflammatory disease, accompanied by hematological
abnormalities' including PT-INR, Ddier, and low-Alb.  How hoes authors show Is it really liver-
specific damage? If authors have evaluated liver biopsies, these parameters would strengthen
evidence, but at this point, we cannot understand why these omicron is milder phenotype, or
even liver-specific damage by omicron, or SARS-Cov-2.
assistant