Review for 10.1186/s12876-019-0941-0 (2019)

Reviewer ’s report  
 
Title: Elevated D -dimer is Assoc iated with Increased 28 -day Mortality in Acute -on-Chronic 
Liver Failure in China: a Retrospective Study  
 
Version: 1 Date: 22 May 2018  
 
Reviewer: Jun Chen  
 
Reviewer's report:  
 
In this manuscript ，Jinjun Chen et al. revealed a nonlinear relation between D -dimer level and 
28-day mortality with a turning point at 6.5 mg/L FEU in ACLF. Statistically, they calculated 
odds ratios of D -dimer level for risk of 28 -day mortality by logistic regression analys is with non -
adjusted and multivariate -adjusted models. They demonstrated that D -dimer was associated with 
short -term prognosis. In my opinion, this article offers a quotable experience in predicting short -
term prognosis in ACLF patients. However, there are  some minor deficiencies.  
 
 
1. The authors mentioned that D -dimer levels positively correlated with all conventional 
prognostic predictive scores (MELD, MELD -Na, CLIF -OF, CLIF -C Ads, CLIF -C 
ACLFs), but not explored and compared the value of the latter's in  predicting prognosis 
of ACLF patients.   
 
 
2. In this single -center retrospective study, it's special that the vast majority of the ACLF 
patients had HBV related chronic liver disease, other than NASH, HCV, and other liver 
disease in West. It is appropriat e to highlight "in China" in the title and abstract, which is 
conducive to understanding of global readers.  
 
 
3. The cut -off value of D -dimer lever （6.5 mg/L FEU) was identified as the turning point 
of the adjusted smoothed plots in Figure.3. So, marking out the precise location of the 
turning point would be appropriate. In addition, the authors compared the clinical data of 
the patients with less D -dimer lever and high D -dimer lever in Table.1. they should 
illustrate how to group all patients in the beginning of the Results.  
 
 
 
 
 
 
 
 
 
 
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.  
 
Unable to assess  
 
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 manus cript or would you recommend 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the follo wing 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 
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 com peting 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.  
 
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I agree to the open peer review policy of the journal