Review for 10.1186/s12876-022-02446-z (2022)

Title: Elevated Serum Ferritin Levels are Associated with Severity and Prognosis of Severe
Acute Pancreatitis: A Preliminary Cohort Study
Version: 1 Date: 31 Mar 2022
Reviewer:  Murat Saruç
Reviewer's report:
I have read the paper named “Elevated Serum Ferritin Levels are Associated with Severity and
Prognosis of Severe Acute Pancreatitis: A Preliminary Cohort Study“ with great interest. The
article is about an important clinical problem for physicians who manage patients with acute
pancreatitis. The need for a perfect marker to predict disease severity in patients with acute
pancreatitis has been the subject of many studies for decades. Using a simple, easily available
marker like SF may be a practice changing innovation. Even this seems well thought and planned
retrospective study, I have some comments and criticism.
Introduction:
1-Referans 1 must be placed at the end of first sentence. Since it is nothing to do with severity
classification systems.
2-Second sentence which is about revised Atlanta classification must be cited to original revision
article (Banks PA,  Gut 2013) In your reference 12 names are incorrectly written, should be
corrected.
3- References should be relevant with the information given in the article. Authors mostly used
studies that the information is present but not the original source of the data. This way of citation
of cited data may be subject of conflict. If possible, authors should find the main study which
is the real owner of the information used in the article.
Materials and Methods:
4-There is no definitive time for SF level. “SF were measured in first 72 hours” may not be
conclusive. Many well establish scoring systems have been criticized for their late results (>48
h). So, if the SF level on admission is valuable it will increase the usefulness of the marker.
It should be made clearer what were the levels of SF at 24, 48 and 72 hours. Is SF getting
gradually increased during the course of acute pancreatitis. Or is early single test enough to
predict the severity? Is SF cut-off value valid anytime or just after 72 hours?
5- CRP is most common used inflammation marker in daily clinical practice so why have the
authors not compare the predictive value of CRP and SF.
Results:
6- Table-1, under severity section MAP has seen in 149 patient and 94 of them had normal SF
which is 63.9% was shown as 87% in the table (the percentage of normal SF in MAP out of
all normal SF patients. This approach is making the data difficult to be understood). You are
proving us that 59.8% of high SF was seen in MAP. This is confusing, one can claim that almost
2 out of 3 patients with high SF will have mild course.
7-When the authors use scoring systems to compare with SF levels, the patients should be
divided into subgroup according to severity. In table 1 the highest Ranson score is 2 which is
still indicating MAP as Ranson>3 predicts severe acute pancreatitis. Same problem exists for
BISAP and CTSI too. Their highest values under high SF column still reveals that they are mild
acute pancreatitis overall.
8- Defining a cut-off value is the striking result of this study. So the authors should re-arrange
the tables according to cut-off value. Then the tables may become more informative.
9- “*” symbol in the tables are not required. All the statistical results were already fully written
in the table.
Discussion:
10- Results were well evaluated and written. The limitations of the study were perfectly
mentioned in the paper. Defining a cut-off value for SF is the main outcome of the study which
should be discussed more. Clinical importance of SF in the management of AP and practice
changing approaches must be clearly discussed.
References:
11- All references must be checked again carefully and should be corrected for author names
and relevance to cited information.
Murat SARUC MD
Professor of Gastroenterology
Acibadem MAA University, School of Medicine
Department of Internal Medicine
Division of Gastroenterology
Istanbul, Turkey