Review for 10.1186/s12876-022-02407-6 (2022)

Reviewer’s report
Title: 
Poor disease knowledge is associated with higher healthcare service use
and costs among patients with cirrhosis: an exploratory study
Version: 
1 
Date: 
10 Apr 2022
Reviewer's report:
Comments to the Authors
In their cohort of 123 patients, Valery et al. conducted a 'knowledge survey'
about cirrhosis and investigated the impact of having 'good' vs. 'bad' knowledge,
as estimated by a ≥5/8 P score in the authors' survey, on healthcare cost, health-
related quality of life (SF-36) and the rate of one-day (i.e, elective) vs. all-cause
admissions or admissions via the emergency department. 
They also investigated
factors that are associated with having 'good' vs. 'bad' knowledge.
The paper is generally well written, the methods are laid out in satisfying detail,
and the analytic approach and presentation of the results are adequate and avoid
overstatement.
Major points:
1. If I understood correctly, patients were recruited during a visit to one of the
participating centers' outpatient clinic or during hospital admission. At this
timepoint, key data was gathered, most importantly health-related quality of life
data, i.e. SF-36, and sociodemographic and clinical data. The knowledge survey
was conducted via mail approx. 6 to 12 months later. Importantly, physical and
emotional well-being will most likely change within this rather wide time frame.
Even more so if patients were inpatients at the time of recruitment. Thus, the
percentage of patients that were recruited whilst being treated as inpatients
should be reported. It should also be clearly acknowledged in the limitations
section that key readings were gathered at two different timepoints. 
2. Along these lines, it would be interesting to know the mean ± SD time
between recruitment and completion of the 'knowledge survey'.
3. Furthermore, the wide time frame between recruitment and 'knowledge survey'
introduces significant bias, as patients must not be allocated to either group
('good' vs. 'bad' knowledge) retrospectively. I would suggest to start follow-up
(for survival analysis) at survey completion and not at study recruitment.
Minor point:
1. There appears to be a copy/paste mistake in the 'background' section of the
abstract ("during 2018-2We assessed").
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