Review for 10.1186/s12876-021-01774-w (2021)

Reviewer’s report
Title: 
Nomogram for predicting advanced liver fibrosis and cirrhosis in patients
with chronic liver disease
Version: 
0 
Date: 
04 Jan 2021
Reviewer's report:
In this prospective study, authors Rongrong Ding et. al. developed nomograms
based on three different laboratory parameters to distinguish early and advanced
fibrosis and cirrhosis, respectively. Nomograms were then compared to
established scores for estimating liver fibrosis stage (APRI, FIB-4, GPR) and
were shown to be superior in discriminating fibrosis stages. 
The strength of this study are the prospective nature and the availability of liver
biopsy samples and full blood work. Also, nomogram performance was assessed
using calibration plots.
Major comments:
- Regarding the "Ethnic statement" it is stated that only chronic hepatitis patients
provided written consent, however in the "Patients" section it is stated that also
patients with ALD, NAFLD and autoimmune hepatitis were included. Please
change the "Ethnic statement" into "all included patients provided written
consent" if this was the case. Otherwise, patients without consent have to be
excluded from the study.
- Validation of the nomograms: The authors emphasize the missing independent
validation that need to be done with further patient data and larger cohorts.
However, the authors also did not include internal validation (e.g. cross-
validation) using randomized patient data sets. Please state why internal
validation was not performed.
- Please give more insights into the choice of using PIIINP as a third marker
since it is not routinely used in assessing fibrosis or liver function nor widely
available in routine lab tests. Maybe the fourth best (more established) marker
would have been more appropriate to use for calculating the nomograms.
Minor comments:
- Please change "prognostic nomogram" to "predictive nomogram" in the results
section (page 9, line 17) since prognostic implies the probability of an outcome
over time
- Typo in the abstract, nomogram is misspelled (page 4, line 17)
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes