Review for 10.1186/s12876-024-03501-7 (2024)

Title: Liver histology pattern of young patients with inactive chronic hepatitis B virus infection
from a Hospital in South West Nigeria
Version: 3 Date: 20 Jul 2024
Reviewer's report:
This study addresses an important topic in chronic hepatitis B management: liver histology in
young, asymptomatic patients with inactive infection. Given the high prevalence of hepatitis B
in sub-Saharan Africa and limited data in this population, such a study could add to the growing
body of evidence on the topic.While the research addresses an important topic, there are several
concerns that warrant attention.
- Study Design and Methodology: The authors' use of a single time point for ALT and HBV
DNA measurements to define inactive CHB is a limitation. Multiple measurements over time
would provide a more reliable classification and stronger justification for performing liver
biopsies. Additionally, the study would benefit from a discussion of quality control measures
for laboratory tests (ALT, HBV DNA) and standardization of ultrasound assessments to ensure
reliability of results.
- The authors have presented a wealth of valuable data in their tables, and there are opportunities
to enhance the clarity and impact of this information. To optimize the presentation, I suggest
focusing on reporting raw numbers and percentages for positive findings only, which would
effectively convey all necessary information while reducing redundancy. This approach would
make the tables more concise and easier to interpret. In the statistical reporting tables,
concentrating on p-values or confidence intervals would streamline the presentation while still
effectively communicating statistical significance. These refinements would make the tables
more accessible to readers. Additionally, the study's insights could be further enriched by
including tables that show bivariate and multivariate associations between the outcomes of
interest and baseline characteristics. Such additions would provide a more comprehensive view
of the data, allowing readers to better understand the interplay between various factors and the
main outcomes.
- The use of a Venn diagram to present histological findings is unclear in its benefit and
message relay. A more straightforward presentation method might better convey this important
information.
- The authors have the baseline data necessary to calculate non-invasive fibrosis scores such
as APRI and FIB-4. Including these widely used scores would add valuable context to the
histological findings and enhance the study's clinical relevance.
- The authors suggest that liver biopsy may be useful in inactive CHB patients but do not
adequately address the potential risks and costs associated with widespread biopsy in this
population. A more balanced discussion of the risk-benefit ratio is warranted.
- Unexplained Findings: The high rate of bilirubin elevation compared to AST/ALT elevation is
not well explained. Similarly, the high rate of hypoalbuminemia is notable and deserves further
discussion, as these findings seem unusual for a population of inactive CHB carriers.
- Confounding Factors: The study would benefit from a discussion of potential confounding
factors that could influence liver histology, such as medications or other medical conditions.
Additionally, there is limited discussion of environmental or lifestyle factors (e.g., alcohol
consumption, obesity) that could impact liver histology.