Review for 10.1186/s12876-025-03719-z (2025)

Title: Treatment Outcomes of Chronic Liver Disease and Associated Factors among patients
treated at hospitals in Bahir Dar city, North-west Ethiopia
Version: 3 Date: 30 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the background offers a broad overview of CLD, there are some sections where
definitions and descriptions could be made more concise. For example, the definition of
chronic liver disease could be rephrased for greater clarity and to avoid repetition. The
phrase "persistent decline of liver functions" is vague—consider specifying the exact functions
(e.g., detoxification, protein synthesis, etc.) and emphasizing the clinical significance of these
declines.
-The manuscript mentions various complications of cirrhosis (e.g., hepatic encephalopathy,
ascites, and variceal bleeding), but the terminology could be more consistent. For instance,
"hepatocellular carcinoma" (HCC) is introduced in the middle of a list without a clear transition.
A clearer structure that first defines cirrhosis-related complications and then transitions into
HCC would improve readability.
-The statistics presented on CLD mortality could be more precise by citing specific sources,
such as the World Health Organization (WHO) or other reputable studies. The claim that "CLD
is the eleventh leading cause of death worldwide" would be more robust with a citation to a
specific source.
-In the bivariate and multivariate analyses, the results could benefit from clearer reporting.
Specifically, the interpretation of the odds ratios (AORs) could be expanded to clarify their
clinical significance. For instance, the finding that decompensated cirrhosis increases the risk
of poor treatment outcomes by 2.7-fold is clear, but providing a brief explanation of how this
translates into clinical practice (e.g., impact on prognosis, need for more intensive treatment)
would be helpful.
-The study uses tables to present data (Tables 1, 2, and 3), but it would be helpful to ensure that
all results from statistical tests (e.g., p-values, AORs, confidence intervals) are clearly labeled
and easy to interpret. For example, in Table 3, the association between treatment duration and
poor treatment outcomes could be more clearly summarized, with the odds ratios and their
significance highlighted.
-While the study mentions that male gender and rural residence were associated with a higher
prevalence of CLD, the discussion could expand on the implications of these findings. For
example, is there a higher incidence of viral hepatitis or parasitic infections in rural areas? What
role might socioeconomic status, healthcare access, and health education play in the disparity
between urban and rural populations?
-The discussion compares the mortality rate in this study with those in other studies from
Eritrea and Ethiopia. This is useful, but the discussion would benefit from further analysis of the
reasons for the differences in mortality rates. For instance, do the differing mortality rates reflect
differences in disease severity, healthcare access, or therapeutic interventions? Could the lower
mortality rate in this study be indicative of earlier detection or more effective management?