Review for 10.1186/s12876-025-03857-4 (2025)

Title: Diagnostic performance of a new algorithm combining simple, non-invasive and
inexpensive tests for predicting the presence of advanced liver fibrosis in patients with chronic
hepatitis B.
Version: 4 Date: 25 Sep 2024
Reviewer's report:
The title of this article initially suggested it fell within my professional expertise, but after
learning the full text, the content of this article is not easy to understand and grasp. This likely
stems from my unfamiliarity with statistics and the methods used in this study. Despite revisiting
the material four times and validating it against data from 144 patients with conditions similar
to those studied over the past five years in our hospital, we have a preliminary understanding
of the algorithm provided, and there may still be understanding errors, so relevant suggestions
are only for reference.
Overall, from the results of this study, the obtained prediction method conforms to the non-
invasive and economical characteristics mentioned in the title. However, the application of the
prediction method is not clear,, there are many levels in the execution of the prediction, and
some variables are reused, it is not convenient to use compared with the free calculation links of
APRI and FIB-4 provided by WHO guidelines. Meanwhile, it is unknown how factors such as
race and gender affect its predictive results. I hope to make modifications around these issues.
1.According to the relevant guidelines referenced in this paper, liver fibrosis is the result of
inflammation and necrosis of liver tissue, although chronic HBV infected persons in the immune
control stage may have severe liver fibrosis or even cirrhosis, it is not an antiviral indication.
Therefore, how to avoid mistakenly including some infected persons in the immune control stage
into treatment without the quantitative increase of HBV DNA and other factors?
2.As can be seen from the prediction decision tree, variable platelets are used repeatedly (4
times), but the meaning of each use may not be simply marked as shown in the figure, which
may easily lead to misunderstanding / miscalculation by readers, the author should indicate or
annotate it.
3.In general, AST levels are positively correlated with the degree of liver damage, the platelet
count is negatively correlated with the degree of liver fibrosis, but this prediction decision tree
seems to be exactly the opposite, which is puzzling.
4.Although APRI and FIB-4 are derived from HCV infection, they have been clinically familiar
and often applied to CHB, and are recommended by the 2024 WHO CHB guidelines (calculation
link is free). It may be better to provide comparison results with them (including Fibro scan,
etc.) to further understand the advantages and disadvantages of the prediction method.
5.The performance of predicting the degree of liver fibrosis is poor and varies greatly. Through
our verification of 144 patients with similar conditions over the past 5 years to the subjects of
this study, the predicted PPV for those with no or mild liver fibrosis and significant liver fibrosis
was 16.7% to 78.5% and 0% to 73.3%, respectively.
6.In the text, validation group (n =194) should describe baseline characteristics; The upper limit
of normal value of the variables used and the gender difference should not should not be confined
solely to the ALT item.
7.Does the abbreviation CHB refer to chronic HBV infection or chronic hepatitis B#chronic
hepatitis B virus carriers#chronic hepatitis# It should be clear and consistent throughout the
entire text.
8.Race, gender, HBV DNA quantification, and other factors often affect the determination of
results, but they are not mentioned in this article. We hope the author can provide further
explanation.
9.The citation format of references should be further standardized and unified.