Review for 10.1186/1471-230X-11-44 (2011)

Reviewer's report
Title:A comparison of four fibrosis indexes in chronic HCV: Development of new
fibrosis-cirrhosis index (FCI)
Version: 1Date:29 December 2010
Reviewer: Ned Snyder
Reviewer's report:
Major compulsory revisions:
1.Please mention how the patients were chosen for the study (ie were these
patients being evaluated for therapy,etc.)? Was it prospective and were these
consecutive patients? Biopsing some obvious cirrhotic patients can be good for
the data but one does not need a hepatic fibrosis marker in these patients.
2. The FIB 4 was designed to differentiate F0-F2 from 3-F4 not F0-F1 from F2-4,
and the cut-offs were designed for this purpose. Therefore it should not be used
to compare with an index designed to distinguish F0-F1 from F2-F4 unless the
authors have some data to support good cut offs for using it to distinguish no/mild
from significant fibrosis.In a small study in co infected patients we found that the
Fib 4 was good for identifying mild from significant fibrosis at cut offs of 1.39 and
2.05 (Trang et al Clinica Chem Acta 397 (51-58).I would probably compare it
separately with the new index for F0-F2 versus F3-F4
3. The mean APRI and Fib 4 scores for the F0-F1 group are quite high.The mean
APRI 0f 1.24 is actually above the cut off we found for significant fibrosis, and is
considerably higher than other groups have found for mild fibrosis. This should
be addressed. This obviously raises the question whether this is an group of
patients with somewhat advanced fibrosis, and that the pathology readings may
underestimate the degree of fibrosis.In an advanced group of patients, the
albumin and bilirubin will obviously be more useful.
4. I have some problems following the predictive values. For instance, the NPV
for fibrosis for the APRI <0.5 is only 61% while the PPV is higher? I think the
table 3 should show actual numbers as well as percentages.
5. I would shorten the discussion. The purpose of the paper is to show the
validity of a new fibrosis index. I do not believe the long discussions of genotype
and viral load are needed except I would simply state in a couple of sentences
that genotype did not seem to play a role, and that viral loads varied with stage.I
would only use points that address the new index and those with which it is
comparedre
Minor essential revisions:
Background: Rewrite the last sentence in the first paragraph.
I do not believe the consensus is that genotype and viral load are related to
fibrosis progression. This whole sentence needs references.
Methods:In line 7, word other not needed.
Results:First paragraph:I am not sure what the terms mild chronic hepatitis,
moderate chronic hepatitis, etc mean-does this refer to the inflammatory grade? I
would use mote modern quantitative terminology
Discretionary revisions:
This is the first paper of which I am aware that finds the alkaline phosphatase
useful in a fibrosis index.High alkaline phosphatase levels in HCV often have
been thought to reflect fatty change, which is prominent in genotype 3. It would
be interesting to know how much fat was on the liver biopsies and whether this
correlated with the AP and whether genotype 3 accounted for the higher AP
levels.Fat also predisposes to fibrosis.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare I have no competing interests