Review for 10.1186/s12876-022-02406-7 (2022)

Reviewer’s report
Title: 
The impact of serum thyroid-stimulation hormone levels on the outcome
of hepatitis B virus related acute-on-chronic liver failure: an observational study
Version: 
1 
Date: 
01 Dec 2021
Reviewer's report:
This is a retrospective study of hepatitis B virus related ACLF. Authors have
studied the role of TSH as a predictor of 30 days and 90 days survival.
I have the following comments
1. Definition of ACLF was used as given by APASL(P7, L154) but APASL
definition does not require TSB >10 times normal elevation for the diagnosis.
2. Figure 1: 579 wee excluded due to incomplete data and loss to follow-up.
Both these groups shall be described separately. The follow-up period before the
loss to follow-up shall be described. It is not appropriate to exclude the loss to
follow-up from analysis because it is introducing a large source of selection bias.
Loss to follow-up are very importangt because the primary outcome measure is
survival and ACLF patients are at high risk of death after discharge.
3. TSH has no direct effect on liver of other organ system or inflammation or
immunity. All the effects of TSH are mediated through T3 or T4. Why authors
have not measured and analyzed T3 and T4 instead of TSH. Entire discussion is
also focussed on TSH but not on thyroid hormone.
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Is the study design appropriate to answer the research question (including the use
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