Review for 10.1186/s12876-023-02684-9 (2023)

Reviewer’s report
Title: 
The role of high serum triglyceride levels on pancreatic necrosis
development and related complications
Version: 
0 
Date: 
24 Nov 2022
Reviewer's report:
The authors investigated the role of elevated triglycerides in patient with acute
pancreatitis and its association to the extent of pancreatic necroses. The study
was performed as a single center prospective study. They found triglyceride
levels over 200 mg/dl associated with increased extend of pancreatic necrosis,
which itself is a known predictor (which could repeatedly be shown) for severe
course of pancreatitis. 
The finding of the study is not absolutely new, but there are only few studies
with partially contradicting results. Overall the objective of the study is of
special interest, especially regarding its diagnostic or therapeutic value. 
However, the methodology used raises some concerns which need to be
addressed: 
- Are the levels of the triglycerides fasting or under which conditions have they
been drawn?
- Alcohol consumption is known to increase triglycerides. Therefore, it is not
surprising that patients with alcoholic pancreatitis are more frequent in the high
triglyceride group. However, alcohol consumption was not associate with more
necroses. This need to be discussed and it would be great to see a calculation for
this. 
- CT-scan is not necessary for uncomplicated course of pancreatitis. This does
not exclude pancreatic necrosis or fluid collections. I would be interested in
triglyceride level those patients excluded for missing CT. Moreover, its irritating
to me that the vast majority of the patients in the center had a CT performed,
which is usually not necessary. Could the authors explain that?
- Additionally, the authors made a citation on the revised Atlanta criteria in the
methods that typical pain, >3-times lipase/amylase AND imaging (3 of 3) are
necessary for making diagnoses of acute pancreatitis. Is this a writing mistake or
are the authors serious about this (which would explain the high number of CT-
scans). 
- Did the authors retrospectively assure hypertriglyceridemia in patients
excluded from the study? If not, I think it might be a mistake to exclude patients
from analysis just because they have triglyceride level possibly causing
pancreatitis, since it is only a possibility. The definition of HTG pancreatitis is
just arbitrary. 
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Is the study design appropriate to answer the research question (including the use
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