Review for 10.1186/s12876-020-01581-9 (2020)

Reviewer’s report
Title: 
Ambulatory end-stage liver disease in Ghana; patient profile and utility of
alpha fetoprotein and aspartate aminotransferase - platelet ratio index.
Version: 
1 
Date: 
26 Apr 2020
Reviewer's report:
The results communicated in this paper are not absolutely new. However there
are only limited data from Ghana concerning epidemiology and socioeconomic
characteristics of patients with end stage liver disease (ESLD). Therefore the
authors have to be congratulated to have collected these important data, which
show, that diagnosis and treatment of patients with ESLD in Ghana has to be
improved urgently.
However I have a few concerns:
The "Gold Standard" for diagnosis of cirrhosis in this paper seems to have been
ultrasound - no liver biopsies and no elastography was performed. Therefore it
might well be, that the proportion of patients with CHILD A cirrhosis has been
underestimated, and so - from a scientific point of view - it is problematic to
conclude that most cirrhotic patients presented with decompensated cirrhosis.
Despite this fact I am sure that this conclusion is true - however, the problem of
a potential underestimation of the number of CHILD A cirrhotics should be
discussed (for example under the heading "limitations" in the chapter
"discussion".
Diagnosis of HCC was only based on ultrasound and it seems that no imaging
with intravenous contrast material was done. This may decrease sensitivity and
specificity of the diagnosis of HCC. I assume that these investigations could not
be done because of financial restrictions - but this fact, too should be discussed
as a limitation of the study.
In table 3 the specificity of AFP testing is reported under the heading "All HCC".
According to my understanding the specificity of a method can only be assessed
in a population NOT affected by the disease (in this case in NON-HCC patients).
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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