Review for 10.1186/s12876-020-01413-w (2020)

Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 12 May 2020
Reviewer: Gabriele Spoletini
Reviewer's report:
The Authors report on a cross-sectional study comparing the performance of conventional
coagulation tests with thromboelastography in ACLF and non-ACLF patients. As cirrhotics canexperience erratic coagulation conditions which are not entirely captured by CCTs, ROTEM hasalready been shown to provide a more thorough picture of their clotting status.The manuscript is well-written and reads smoothly.I see there has been an integration regarding the correlation between bleeding events and ROTEMresults, which I think is interesting.Weakness of the work is limited novelty as the topic has been explored already. However, I think itstill adds some knowledge to the field.
My observations regarding the work are:
1.Methods in Abstract should include a concise explanation of how the work intends to addressthe primary objective of the study.2.Line 214: "more frequently that CCT" should be "than".3.When was ROTEM performed? This should be specified even if no specific time of testperformance was contemplated in the study. I read "Clinical and laboratory data were collected
within 24 hours of admission". Does this include ROTEM?
4.Lines 311-313: "Based on our results, one can speculate that particularly in the ACLF patients -with a high frequency of pathological coagulation based on CCT -transfusion regimens based onROTEM could lead to much lower transfusion requirements". I can grab the concept (i.e.,transfusion policy can be guided by ROTEM results instead of using CCT) but this should beprobably rephrased.5.Line 321 "as prognostic important factors" should be "as important prognostic factors"6.Supposedly, almost all ACLF admissions were emergency. It would interesting to know howmany elective admissions there were in the Non-ACLF group (I see a relevant proportion ofpatients were admitted for TACE, therefore coming from home in an expectedly balanced clinicalstatus) and how many had acute decompensation.7.I would expand a little on Limitations of the work and explain what the work adds compared toprevious articles on the same topic.
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:
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