JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-03785-3 (2025)

Title: Diagnostic performance of contrast-enhanced CT combined with contrast-enhanced MRI
for colorectal liver metastases: A case-control study
Version: 2 Date: 09 Mar 2025
Reviewer's report:
This is the second revision of the manuscript, so I am trying to keep it short.
As I said previously my main concerns were just formally. You did an extensive second revision
on the manuscript and I am mainly satisfied with the results.
However, there are still some flaws in the "Sample size estimation" section.
• p1p_1p1 = Expected sensitivity for CT (0.80)
• p2p_2p2 = Expected sensitivity for MRI (0.70)
• mmm = Matching ratio (1:1)
I don't know what means "p1p-1p1", "p2p-2p2" and "mmm"? These terms are not found in the
formula above.
• Z1##/2Z_{1-\alpha/2}Z1##/2 = Z-score for a 95% confidence level (1.96)
• Z1##Z_{1-\beta}Z1## = Z-score for 80% statistical power (0.84)
It seems to be quite difficult to write an alpha/beta as an  "#"/"#".
Again, the  study  is  otherwise  methodologically  ok  and  the  results  are  not  surprising. The
second revision improved the manuscript substatially.
Review for 10.1186/s12876-025-03762-w (2025)

Title: The Role of the Advanced Lung Cancer Inflammation Index (ALI) in the Risk of
Liver Fibrosis and Mortality Among US Adult MAFLD Patients: A Cross-Sectional Study of
NHANES 1999–2018
Version: 1 Date: 17 Dec 2024
Reviewer's report:
The manuscript titled "Associations of Nutrition and Inflammation with the Risk of Liver
Fibrosis and Mortality in NAFLD Adults: the Result of NHANES 1999–2018" provides an
intriguing examination of the role of the Advanced Lung Cancer Inflammation Index (ALI)
in predicting liver fibrosis and mortality in patients with Non-alcoholic Fatty Liver Disease
(NAFLD). While the study's approach and dataset are commendable, several aspects require
improvement to enhance the clarity, impact, and reliability of the findings. Below are the specific
suggestions for revision:
1. Clarify Abstract Objectives: The abstract should more explicitly state the study’s primary
objectives, including a clearer explanation of how ALI correlates with NAFLD progression and
mortality, to better align with the detailed objectives mentioned in the introduction and methods
sections.
2. Enhance Background Context: The background section should provide a more comprehensive
review of previous studies regarding ALI in other non-cancer conditions to establish a stronger
rationale for exploring its use in NAFLD.
3. Address Sample Selection Bias: Discuss the potential biases introduced by excluding
individuals with significant missing data or certain comorbidities, and how these exclusions
might affect the generalizability of the findings.
4. Interpret Non-linear Relationships: Provide a more detailed interpretation of the non-linear
relationships observed between ALI and the study outcomes. Discuss potential biological or
clinical reasons for these patterns and their implications.
5. Expand Discussion of Limitations: More thoroughly discuss the limitations associated with
using a cross-sectional design, particularly the inability to infer causality between ALI levels
and outcomes in NAFLD.
6. Enhance Novelty and Contribution: The manuscript should more explicitly highlight its novel
contributions to the existing body of knowledge. This can be achieved by adding a section or
a paragraph in the Discussion that contrasts the findings with existing literature, particularly
focusing on how this study's use of ALI in NAFLD patients adds new insights or contradicts
previous research. Detailing the unique aspects of the study's approach and findings will help to
underline its significance and justify its publication.
Review for 10.1186/s12876-025-03762-w (2025)

Title: The Role of the Advanced Lung Cancer Inflammation Index (ALI) in the Risk of
Liver Fibrosis and Mortality Among US Adult MAFLD Patients: A Cross-Sectional Study of
NHANES 1999–2018
Version: 2 Date: 02 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the ALI is well-justified in terms of its role as an inflammatory and nutritional marker,
the manuscript would benefit from a deeper discussion of the biological mechanisms linking
ALI to liver fibrosis in MAFLD. The authors could elaborate on how BMI, albumin, and NLR
are related to liver inflammation and fibrosis progression. The current explanation lacks clarity
on how these components interact in the liver microenvironment.
-It would also be helpful to compare ALI to other known inflammatory markers in MAFLD (e.g.,
C-reactive protein (CRP), NLR) and explain why ALI is specifically chosen. While the index
has been used in various cancer-related and inflammatory conditions, MAFLD-specific studies
are limited, and further justification would strengthen the rationale for its use in this population.
-The manuscript uses the USFLI index to define fatty liver, but it would be useful to provide more
information on the sensitivity and specificity of the USFLI compared to imaging or histological
assessment of liver steatosis. While the use of USFLI is appropriate for large population studies,
its limitations in diagnosing MAFLD could impact the validity of the findings. A brief discussion
of how the USFLI compares to other diagnostic criteria for fatty liver disease would strengthen
the study's diagnostic accuracy argument.
-While the authors adjust for many important covariates (e.g., age, sex, BMI, smoking, alcohol
consumption), the manuscript could further clarify how the covariates were chosen. Were these
based on prior literature, or were they identified through exploratory data analysis? Providing a
more explicit rationale for the selection of specific covariates, particularly lifestyle factors like
physical inactivity or dietary intake, would enhance transparency and ensure that the analysis
adequately addresses potential confounding.
-The stratified analyses by central obesity, prediabetes, and alcohol consumption provide
important insights into how these factors influence the relationship between ALI and health
outcomes. However, the P-values for interactions (e.g., alcohol consumption and low HDL-
cholesterol) are reported as significant, but the actual interaction effects are not sufficiently
detailed. Providing a more thorough interpretation of these interactions, including the magnitude
of effect and clinical relevance, would enrich the discussion.
Review for 10.1186/s12876-025-03762-w (2025)

Title: The Role of the Advanced Lung Cancer Inflammation Index (ALI) in the Risk of
Liver Fibrosis and Mortality Among US Adult MAFLD Patients: A Cross-Sectional Study of
NHANES 1999–2018
Version: 2 Date: 03 Jan 2025
Reviewer:  Amira A A Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-03762-w (2025)

Title: The Role of the Advanced Lung Cancer Inflammation Index (ALI) in the Risk of
Liver Fibrosis and Mortality Among US Adult MAFLD Patients: A Cross-Sectional Study of
NHANES 1999–2018
Version: 3 Date: 29 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory.
Review for 10.1186/s12876-025-03762-w (2025)

Title: The Role of the Advanced Lung Cancer Inflammation Index (ALI) in the Risk of
Liver Fibrosis and Mortality Among US Adult MAFLD Patients: A Cross-Sectional Study of
NHANES 1999–2018
Version: 3 Date: 09 Feb 2025
Reviewer's report:
Given the updated definition of MASLD (Metabolic Associated Steatotic Liver Disease),
the entire analysis would indeed need to be revisited. This change may have implications
for the diagnostic criteria and risk factors associated with the condition, which would affect
the study's results and conclusions. It would be important for the authors to update their
definitions, methods, and interpretations accordingly to align with the new terminology and
clinical understanding. Revisiting the relationship between ALI and MASLD using the updated
framework would strengthen the manuscript and ensure its relevance in light of the new
definition.
Review for 10.1186/s12876-025-03762-w (2025)

Title: The Role of the Advanced Lung Cancer Inflammation Index (ALI) in the Risk of
Liver Fibrosis and Mortality Among US Adult MAFLD Patients: A Cross-Sectional Study of
NHANES 1999–2018
Version: 4 Date: 01 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03762-w (2025)

Title: The Role of the Advanced Lung Cancer Inflammation Index (ALI) in the Risk of
Liver Fibrosis and Mortality Among US Adult MAFLD Patients: A Cross-Sectional Study of
NHANES 1999–2018
Version: 4 Date: 04 Mar 2025
Reviewer:  Amira A A Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-03740-2 (2025)

Title: The Impact of Probiotic Supplementation on Gastric Motility and Nutrient Absorption in
Elderly Patients with Gastrointestinal Disorders
Version: 0 Date: 19 Dec 2024
Reviewer:  Qiaochu Liang
Reviewer's report:
Summary: This manuscript examines the effects of the probiotic Lactobacillus rhamnosus GG
(LGG) on gastric motility and nutrient absorption in an elderly population with gastrointestinal
(GI) disorders. The study addresses an important area of research, providing potential insights
into the benefits of probiotics for this specific group of patients. However, there are significant
issues with how the data have been presented and interpreted (outlined below).
Major issues:
1. The intervention group was instructed to take the probiotic twice daily. However, the
commercial product (Culturelle) recommends one capsule per day. Please address the rationale
for deviating from the standard dosage and its potential impact on the study's outcomes.
2. The manuscript does not specify whether participants' prior or concurrent consumption of
other probiotics or prebiotics was monitored during the study period. These factors could
influence the outcomes. Please clarify whether such data were recorded and, if not, discuss the
potential implications.
3. The focus of the analysis appears to be on comparisons between the treated and non-treated
groups. However, the manuscript neglects comparisons within each group before and after the
intervention. Furthermore, significant changes are observed within the non-treated (NPS) group,
even without the intervention, which is puzzling. Authors should consider a better way to present
the data and elaborate on these unexpected changes in Sections 3.2, 3.3, and 3.4.
4. Both Table 6 and Figure 4 omit pre-treatment data, which is critical for understanding the
baseline conditions of the participants.
Minor:
1. In Section 2.3, the statement, "All patients had a total daily energy intake ranging from 1800
to 2400 calories [13]," lacks clarity regarding the relevance of the cited reference. Did the study
adopt the methodology from the referenced source to measure energy intake? Please revise
the statement to clarify this connection and ensure the relevance of the reference is explicitly
addressed.
2. In Section 2.5 “These samples were centrifuged at 4000 rpm for 10 minutes using a low-
temperature high-speed centrifuge (Mini1524, Zhuhai Hema Medical Instrument Co., Ltd.,
China) and subsequently stored at low temperatures for future analysis” and Section 2.6 “These
samples (3 ml each) were centrifuged at 3000 rpm for 5 minutes using a low-temperature high-
speed centrifuge”, please specify “low temperature” for both centrifuge and storage.
Review for 10.1186/s12876-025-03740-2 (2025)

Title: The Impact of Probiotic Supplementation on Gastric Motility and Nutrient Absorption in
Elderly Patients with Gastrointestinal Disorders
Version: 0 Date: 30 Dec 2024
Reviewer's report:
The investigation is interesting but has several drawbacks:
- the design is retrospective and authors must comment on the limitation in the discussion;
- GID is a wide diagnosis and deserves patients disease and syndrome-stratification;
- probiotics use ca n have variegate and  personal-patient effects: are the sample size and methods
used adequate for this ambitious aim ? Wouldn't be better to stratify patients ? in a future trial ?
Review for 10.1186/s12876-025-03740-2 (2025)

Title: The Impact of Probiotic Supplementation on Gastric Motility and Nutrient Absorption in
Elderly Patients with Gastrointestinal Disorders
Version: 1 Date: 26 Jan 2025
Reviewer:  Qiaochu Liang
Reviewer's report:
The revised manuscript has added explanations to issues identified in the previous version. A
few more adjustments are suggested:
1. Please include the statistical methods used for each table and figure in their respective legends.
2. The added text in 2.3 states: “The probiotic administered was LGG (Culturelle®, I-Health Inc.,
USA), given at a dosage of 1 × 1010 colony-forming units (CFU) twice daily, which represents
a modified dosing regimen specifically chosen for this elderly population based on previous
clinical evidence”. Please reference the “previous clinical evidence” if published. If not, please
revise to indicate that it is unpublished preliminary evidence.
3. Authors acknowledged in Sections 3.2, 3.3, and 3.4 of the revised version that before-and-
after changes in the NPS group suggest “potential confounders or natural variations”. Please
expand on the discussion for “potential confounders or natural variations”.
Review for 10.1186/s12876-025-03770-w (2025)

Title: Assessing the consistency of FIB-4, APRI, and GPR in evaluating significant liver fibrosis
and cirrhosis in COVID-19 patients with concurrent liver diseases
Version: 0 Date: 15 Feb 2025
Reviewer's report:
1. We congratulate the authors for developing yet another model for predicting high risk
esophago-gastric varices in patients with Cirrhosis of Liver
2.Authors have not mentioned the indications for doing CT scan
3. When other non invasive models for predicting high risk varices available, how do we justify
a CT based model which poses radiation risk to the patients.
4. Radiation dose not calculated ( May be due to retrospective nature of study)
5. Any non invasive model should be simple, reproducible and cost effective. However any CT
based model will be expensive.
6.Being a retrospective study, authors should have tested this model in few patients prospectively
Review for 10.1186/s12876-025-03770-w (2025)

Title: Assessing the consistency of FIB-4, APRI, and GPR in evaluating significant liver fibrosis
and cirrhosis in COVID-19 patients with concurrent liver diseases
Version: 1 Date: 27 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03770-w (2025)

Title: Assessing the consistency of FIB-4, APRI, and GPR in evaluating significant liver fibrosis
and cirrhosis in COVID-19 patients with concurrent liver diseases
Version: 1 Date: 01 Mar 2025
Reviewer's report:
The manuscript has been revised according to my suggestions and appears improved. I consider
it acceptable for publication
Review for 10.1186/s12876-025-03689-2 (2025)

Title: Study of factors influencing the insertion failure of single balloon enterostomy-assisted
ERC P treatment after bilioenteric Rou-en-Y anastomosis
Version: 3 Date: 21 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction mentions the challenges associated with "intestinal lumen angulation and
stricture due to intra-abdominal adhesions," which is a critical point. However, it would be
helpful to briefly discuss the existing literature on post-Roux-en-Y anatomy and how these
factors specifically impair ERCP insertion. Adding a more in-depth review of related studies
would help to establish the background for why this particular study is important and how it
fills a gap in current knowledge.
-The mention of a “digestive tract structure schema” to guide endoscopic progress is intriguing,
but it is not explained in detail. Was this schema a preoperative imaging study (e.g., CT scan or
endoscopic ultrasound)? Or was it a schematic drawing based on prior knowledge? Providing
more information here would clarify its role in the planning and execution of the procedure.
-The patient cohort is described well in terms of the number of patients and the indications
for ERCP (e.g., intrahepatic stones, anastomotic strictures). However, there is no mention of
whether these patients had any other comorbidities that might influence outcomes (e.g., diabetes,
obesity, or previous ERCP complications). Including these variables in the cohort description
could help in identifying other possible risk factors for insertion failure.
-X-ray imaging is frequently mentioned as a tool to guide the progress of enteroscopy, which
is valuable. However, it would be helpful to elaborate on how X-ray guidance was employed
—was it fluoroscopy? How did it specifically aid in overcoming challenges related to altered
anatomy? Describing this in more detail would give readers better insight into how technology
was integrated into the procedure.
-The recommendations for surgical modifications to improve ERCP outcomes are sound, but
they could be expanded. For example, while the authors suggest shortening the afferent loop and
avoiding U-shaped folding, there is limited discussion of how these changes affect the overall
surgical process or long-term patient outcomes. How do these modifications impact the recovery
and function of the gastrointestinal tract, particularly in patients who may require additional
interventions like PTCD or open surgery?
Review for 10.1186/s12876-025-03689-2 (2025)

Title: Study of factors influencing the insertion failure of single balloon enterostomy-assisted
ERC P treatment after bilioenteric Rou-en-Y anastomosis
Version: 4 Date: 21 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
the responses are satisfactory.
Review for 10.1186/s12876-025-03689-2 (2025)

Title: Study of factors influencing the insertion failure of single balloon enterostomy-assisted
ERC P treatment after bilioenteric Rou-en-Y anastomosis
Version: 4 Date: 25 Jan 2025
Reviewer's report:
You have corrected well in response to the comments.
One point, please consider adding a response to Reviewer 1, major 13, to the METHOD's
DIFFINITION.
Review for 10.1186/s12876-025-03775-5 (2025)

Title: THSD7A as a novel prognostic factor for colorectal carcinoma
Version: 1 Date: 07 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the introduction explains the rationale behind the study, it could be clearer about the
specific research questions. For example, the introduction could more explicitly state whether the
focus is solely on THSD7A as a biomarker for overall survival, or whether it will also consider
its role in disease progression or response to treatment.
-It would be beneficial to briefly mention how THSD7A expression could impact clinical
decision-making or guide therapeutic strategies in CRC, which would help emphasize the
potential translational value of the study's findings.
-While the immunohistochemistry procedure is well-described, the threshold for categorizing
tumors as positive or negative (#1% expression of cancer cells) could be clarified. For instance,
why is 1% used as the cutoff for "positive" expression, and how does this compare with other
studies using similar methodologies? Further justification for this threshold would add clarity.
-While the inclusion criteria are outlined, the description of patient demographics (age, sex, etc.)
is absent. Including this information would be helpful to assess the representativeness of the
cohort. For example, how might age, sex, or tumor location impact THSD7A expression and
survival outcomes?
-While the discussion highlights THSD7A's role in angiogenesis, it could benefit from further
explanation of its exact molecular mechanisms. For example, how exactly does THSD7A
contribute to angiogenesis at the molecular level, and what are the signaling pathways involved?
Adding more details on this could strengthen the argument for THSD7A as a therapeutic target.
-The discussion acknowledges the variability in results across studies regarding THSD7A
expression and its association with pathological features. However, it could benefit from a more
in-depth exploration of these inconsistencies. For instance, what factors (such as sample size,
tissue types, or patient characteristics) might explain the differences in THSD7A expression or
its prognostic significance between studies? This would provide a more nuanced understanding
of the literature and help contextualize the study's results more comprehensively.
-The discussion mentions a lack of association between THSD7A expression and adverse
pathological features in the present study, except for lymphovascular invasion (LVI). It would
be useful to explore why LVI is the only feature correlated with THSD7A expression and what
this may imply about the role of THSD7A in CRC progression. Does this suggest a specific role
for THSD7A in vascular invasion and metastasis?
Review for 10.1186/s12876-025-03775-5 (2025)

Title: THSD7A as a novel prognostic factor for colorectal carcinoma
Version: 1 Date: 13 Feb 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
The clinical implications of THSD7A expression in CRC prognosis and treatment strategies
should be clearly stated. The study should discuss how THSD7A expression could be integrated
into current prognostic models and whether it has potential as a therapeutic target or a biomarker
for patient stratification. A more thorough background is needed in the introduction to justify
the focus on THSD7A in CRC. The biological role of THSD7A in cancer should be expanded,
particularly its function in CRC angiogenesis, metastasis, and tumor progression. Additionally, a
comparison to other angiogenesis-related biomarkers would help contextualize its significance.
The patient selection criteria and exclusion criteria in the study design need further clarification.
It should be explicitly stated why patients with missing data or inadequate tissue were
excluded and whether this introduced any selection bias that could affect the study results. The
immunohistochemistry scoring criteria for THSD7A positivity are not standard, and the cutoff
point (#1% expression) is relatively low. A justification for this threshold should be provided,
citing relevant literature that supports this cutoff. Alternatively, a sensitivity analysis using
different cutoff values could strengthen the validity of the chosen threshold.
The Kaplan-Meier curves (Fig. 2) are missing in the provided document and should be ensured
to be included. All figures must be properly labeled with appropriate legends, and log-rank
test values should be mentioned in the text for clarity. In the multivariate analysis, the hazard
ratios (HRs) are provided, but the confidence intervals (CIs) are quite wide, suggesting potential
overfitting. It would be beneficial to check the proportional hazards assumption for Cox
regression. If sample size is a limitation, bootstrapping methods could be used to obtain more
robust estimates.
The discussion should provide a mechanistic hypothesis explaining why THSD7A behaves
differently in various cancers. Since THSD7A appears to be beneficial in some cancers but
detrimental in others, it is important to explore whether these differences are dependent
on the tumor microenvironment or specific molecular interactions unique to each cancer
type. The study limitations are only briefly mentioned and should be expanded. Potential
biases, particularly those introduced by the retrospective nature of the study, the small sample
size, and the lack of functional validation through in vitro experiments, should be explicitly
acknowledged.
Several key references on THSD7A research, particularly functional studies, appear to be
missing from the references section. Recent studies from 2022 to 2024 that further validate or
contrast the study’s findings should be included to ensure a comprehensive literature review and
strengthen the discussion
Review for 10.1186/s12876-025-03775-5 (2025)

Title: THSD7A as a novel prognostic factor for colorectal carcinoma
Version: 2 Date: 08 Mar 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Author,
Re: THSD7A as a Novel Prognostic Factor for Colorectal Carcinoma
Thank you for submitting your revised manuscript and for addressing the reviewers' comments in
a comprehensive and thoughtful manner. After carefully reviewing both the revised manuscript
and the detailed responses to the reviewers, I find that the revisions satisfactorily address the
concerns raised.
Sincerely,
Review for 10.1186/s12876-025-03771-9 (2025)

Title: Association between the triglyceride glucose index and the risk of acute respiratory failure
in patients with acute pancreatitis
Version: 0 Date: 21 Nov 2024
Reviewer's report:
Thank you for allowing me to participate in the review of this very interesting work. Early
identification of patients at increased risk of developing severe pancreatitis or complications
such as respiratory failure remains of relevant clinical importance. The study objectives are
clear, and the methodology used is correct. I have a few questions that I would like the authors
to clarify:
1. The authors used the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-
IV v2.2) database to conduct the study. Could the authors explain the characteristics of this
database? Does the data only include patients admitted to the intensive care unit? What variables
are included in this database? Does the data include the entire hospital stay?
2. Were patients with a history of hypertriglyceridemia included in the analyzed sample?
3. The etiology of pancreatitis is not described in the results. Does the database have this
information? Could this be a bias in the study?
4. Was the duration of illness from the onset of symptoms to the collection of blood samples for
the study analyzed? Was this similar in the patients included in the study?
Review for 10.1186/s12876-025-03771-9 (2025)

Title: Association between the triglyceride glucose index and the risk of acute respiratory failure
in patients with acute pancreatitis
Version: 0 Date: 17 Dec 2024
Reviewer's report:
This study describes the association between Tyg, a possible marker of insulin resistance, and
ARF in people with acute pancreatitis.
Major remarks : While the authors do show a strong association between high Tyg and ARF,
I feel that it is difficult to understand if using this marker is really more interesting than just
knowing if the patients have diabetes or hypertriglyceridemia.
Indeed, it is already known that people living with diabetes are more at risk of severe AP.
Moreover, people with AP can also present with "stress hyperglycemia", all the more if they
have a severe case, which would also show here: those with severe AP would have higher blood
glucose and thus a higher Tyg.
Accordingly, the subgroup analysis shows that in the "diabetes" or in the "hypertriglyceridemia"
subgroups, TYG was not associated with severity anymore.
Therefore, I think that the authors need to really justify using this marker.
Minor remarks:
- The introduction really lacks references, lots of affirmations are not backed by literature
references in the text.
- In the second sentence, the incidence is in people by year
- I don't think that you can say that impaired endocrine function is characterized by insulin
resistance. Moreover, I think that you could move parts of your discussion to the introduction
to explain more clearly why you want to study insulin resistance in this context.
- In the "data selection" section, you do not explain what "abnormal data" are
- in the statistics, I would think that the model 3 uses too many variables which are correlated,
that coud lead to an "overfitting" and to biased results (for example, I would not put INR and
PT, or RBC and Hb, in the same model). I think you lack a model with age, gender, BMI, fasting
blood glucose and TG, or at least diabetes yes/no and hypertriglyceridemia yes/no).
Review for 10.1186/s12876-025-03771-9 (2025)

Title: Association between the triglyceride glucose index and the risk of acute respiratory failure
in patients with acute pancreatitis
Version: 1 Date: 13 Feb 2025
Reviewer's report:
Thank you for this revision, which improved the quality of your paper!
I still have minor remarks :
- I think you should move the paragraph "Pancreatitis can lead to decreased pancreatic insulin
secretion and increased peripheral IR. Studies had shown that chronic h..., this mechanism could
also contribute to the onset of ARF [22]" from the discussion to the introduction section, in order
to explain why you want to perform your study earlier in your paper.
- I am still not completely convinced about the superiority of Tyg as compared to just checking
if people have hyperglycemia linked to a stress state associated with their severe AP. Maybe
you could just try to compare the ROC of Tyg for ARF prediction vs the ROC of blood glucose
alone or the ROC of TG alone? If the AUC of these isolated variables is lower than the one with
Tyg, you will have a strong argument to say that it is a more interesting marker.
Review for 10.1186/s12876-025-03753-x (2025)

Title: A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver
biopsy
Version: 0 Date: 09 Feb 2025
Reviewer's report:
Thank you for allowing me to review Manuscript entitled "A cost-effective measure to prevent
hemorrhage in ultrasound-guided percutaneous liver biopsy"
The Authors analyzed a total of 462 patients underwent ultrasound-guided liver tissue aspiration
biopsy between September 2019 and March 2023. The participants were divided into two groups,
an observation group and a control group, based on the order of puncture. Each group consisted
of 231 cases.
Authors should enter page number to facilitate review
In Materials and Methods,
Line 5: the Authors not explain how the randomization of the patients. They should explain the
technique used for divided the patients in two group (observation and control)
The Authors report the inclusion criteria, but not exclusion criteria. Please explain the exclusion
criteria.
In Results:
Line 3: the Authors report "The mean time required for haemostasis was 0.4±0.2 minutes." But
this value was only the observation group. Please insert the value of control group.
In Discussion:
Line 15: The Authors report "The incidence of bleeding complications in the control group was
22.1%".
In background report "The risk of bleeding after liver biopsy was 10.9%, which could lead to
patient death [9]."
The Authors should explain because reported value almost double.
In References:
The Authors should revision the "Instruction for Authors" in the site of Journal for revision the
references (Example reference style: Article within a journal: Smith JJ. The world of science.
Am J Sci. 1999;36:234-5.)
However, I think this study needs major revisions.
Review for 10.1186/s12876-025-03753-x (2025)

Title: A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver
biopsy
Version: 0 Date: 11 Feb 2025
Reviewer's report:
The Manuscript is well written and sound. This issue is of great significance for hepatologists
and will be of much interest for clinicians.
There are several points to be considered:
1. 'The risk of bleeding after liver biopsy was 10.9%, which could lead to patient death[9]'.- The
reference is old (9), and from personal experience the rate of bleeding events is lower than 10%.
Authors should refer to newer clinical studies or metaanalysis to discuss this issue.
2. The authors should define in the Introduction, at the very beginning,  that the study is about
biopsies in diffuse liver diseases and not about biopsies of focal liver lesions.
3. 'The mean time required for haemostasis was 0.4±0.2 minutes. '- in the observation group?
4. The authors mentioned direct biopsy technique in the discussion. The authors should  briefly
discuss differences between those 2 techniques  in terms of durations of procedure and reported
rates of side effects since the direct biopsy technique is used worldwide.
5. How was the bleeding episode defined? How was severe bleeding episode defined? Did any
patients underwent operation? Where there any fatal complications?
Review for 10.1186/s12876-025-03753-x (2025)

Title: A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver
biopsy
Version: 0 Date: 14 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although the patients were divided into observation and control groups based on the order
of puncture, the method of randomization is not described. Understanding how patients were
randomly assigned to each group is crucial for ensuring that selection bias did not influence the
results. A more detailed explanation of the randomization process would strengthen the study's
internal validity.
-The method of dividing participants into two groups based on the order of puncture could
introduce bias if the groups are not balanced in terms of pre-existing characteristics (e.g., severity
of liver disease, comorbidities). A more thorough randomization method, such as computer-
generated randomization, would help ensure more balanced groups.
-The study does not mention blinding of either the patients or the operators. Blinding is
important in clinical trials to reduce the risk of bias in data collection, especially with subjective
measurements like the assessment of bleeding complications. The absence of blinding could
introduce observer bias in assessing outcomes such as hemostasis time and bleeding severity.
-Although the study is well-designed for the hospital setting, the methods may not be
generalizable to all healthcare environments. The fact that the study was conducted by a single,
experienced operator raises the question of whether the results could be replicated with less
experienced clinicians or in hospitals with different resources.
-While the discussion reports the effectiveness of AGS-SFA in achieving hemostasis, it could
benefit from a more detailed exploration of how AGS-SFA works at a physiological level.
Understanding the mechanisms of AGS-SFA (e.g., how it absorbs blood or promotes clotting)
would help further solidify its role in liver biopsy and make the findings more robust from a
scientific perspective.
-The observation group had three cases of post-biopsy bleeding, which is acknowledged, but the
explanation remains somewhat speculative. The study suggests this may be due to insufficient
AGS-SFA or overly deep filling, but it would be helpful to explore these cases in more depth.
For instance, was there a specific trend (e.g., liver condition, coagulation status) that could
explain these three instances? A more in-depth investigation of these outliers could strengthen
the findings.
-The discussion focuses on immediate post-biopsy bleeding and hemostasis, but there is little
mention of the longer-term outcomes. It would be useful to know whether there were any delayed
complications (e.g., late bleeding, infection, or other adverse effects) in either group. Including
this information would provide a more complete picture of the safety and effectiveness of AGS-
SFA.
Review for 10.1186/s12876-025-03753-x (2025)

Title: A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver
biopsy
Version: 1 Date: 18 Feb 2025
Reviewer's report:
For Authors
Thank you for allowing me to re-review Manuscript entitled "A cost-effective measure to
prevent hemorrhage in ultrasound-guided percutaneous liver biopsy"
My observations were:
Q1: Authors should enter page number to facilitate review.
A1: The authors did not include the page number in the article.
In Materials and Methods,
Q2: Line 5: The authors do not explain how the patients were randomized. They should explain
the technique used to divide the patients into two groups.
A2: The authors responded
Line 4: "Participants were randomly assigned to either the observation or control group using a
computer-generated randomisation sequence."
Q3: The authors report the inclusion criteria, but not the exclusion criteria. Please explain the
exclusion criteria.
A3: The authors have entered the exclusion criteria after inclusion criteria.
In Results:
Q4: Line 3: The authors report "The mean time required for hemostasis was 0.4 ± 0.2 minutes.
But this value was only for the observation group. Please enter the value for the control group.
A4: The authors responded
Line 4:  "and 5.3±1.7 minutes in the control group".
In Discussion:
Q5: Line 15: The authors report "The incidence of bleeding complications in the control group
was 22.1%".
In the background report "The risk of bleeding after liver biopsy was 10.9%, which could lead
to patient death [9]. "
The authors should explain why the reported value is almost double.
A5: The authors responded
Line 19: " Additionally, the use of real-time Doppler ultrasound likely increased the detection
of subclinical bleeding events that might otherwise go unnoticed in studies relying solely on
clinical symptoms. "
In References:
Q6: Authors should review the "Instructions to Authors" on the journal website for reviewing
references (Example reference style: Article within a journal: Smith JJ. The
world of science. Am J Sci. 1999;36:234-5.)
A6: The authors have modified the references.
For me the article now is acceptable for publication.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 1 Date: 17 Jan 2025
Reviewer's report:
This retrospective cohort study investigates the association between hematocrit (Ht) levels and
mortality in critically ill patients with acute pancreatitis (AP), using data from the MIMIC
database. The authors identify a U-shaped relationship between Ht and 28-day mortality,
highlighting both low and high levels of Ht as independent predictors of adverse outcomes.
Non-linear regression analyses further substantiate the findings, suggesting that Ht could be an
important parameter in prognostic evaluations.
This study adds little novelty to the existing literature, as the association between hematocrit
and outcomes in AP has been well-established since the publication of the Ranson criteria in
1974. The Ranson scoring system, a widely used prognostic tool for AP, incorporates Ht as an
indicator of hemoconcentration, a marker of disease severity. High hematocrit is linked to fluid
loss and hypovolemia, while low levels often result from aggressive fluid resuscitation. These
relationships have been extensively documented in the context of AP severity and mortality.
A notable omission is the lack of citation of the Ranson criteria, which for decades has
included hematocrit as part of its scoring methodology. Ranson's criteria serve as a foundational
framework for predicting outcomes in AP, encompassing parameters like age, glucose, and Ht
changes over 48 hours. Ignoring this critical context weakens the study’s claim of providing
new insights, as the primary associations have long been known and remain clinically relevant.
Given the absence of novel findings and the failure to adequately contextualize the study within
existing literature, I recommend against publication. The study’s conclusion that Ht correlates
with mortality in AP reiterates what has been known for nearly five decades without offering
new mechanistic insights, innovative methodologies, or significant clinical implications. This
lack of originality diminishes the paper's contribution to advancing the field.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 1 Date: 20 Jan 2025
Reviewer:  Suzan Hamed
Reviewer's report:
In this study of Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study, the authors did an effort to study the relation between
hematocrit level and mortality in patient with acute severe pancreatitis.
However, in the study population the authors didn't mention the time scale of their study
population admission and data collection.
The study is retrospective with too many confounding factors that can affect survival in the study.
The topic isn't novel it has been studied many times before.
The research results will not significantly impact therapeutic intervention in the study
population.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 1 Date: 21 Jan 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The manuscript is presented well and investigates an important
question in clinical pancreatology.
REQUESTED REVISIONS:
The following comments may help improve the manuscript:
1. Please specify the differences between the MIMIC-IV and MIMIC-III datasets.
2. What was the time period between hospital admission and ICU admission?
3. Were data missing completely at random?
4. Please investigate cause-specific mortality as a secondary endpoint.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 1 Date: 22 Jan 2025
Reviewer:  Mohammad Reza Hatamnejad
Reviewer's report:
“Peer-reviewed report”
Thank you for the opportunity to provide a peer review for this article on " Association between
hematocrit and mortality in critically ill patients with acute pancreatitis: a retrospective cohort
study." This retrospective cohort evaluated data of patients with acute pancreatitis who were
admitted in ICU and authors aimed to determine whether hematocrit (HCT) can predict mortality
in these patients.
Here are some comments that may help authors to boost the paper's quality:
1. To enhance clarity, it would be beneficial to include “all-cause mortality” in the title.
Additionally, specifying “short-term all-cause mortality” could provide further precision.
2. In the background section, the authors primarily discuss the debate surrounding the prognostic
utility of elevated HCT levels. However, the paper appears to focus more on determining both
high and low prognostic HCT levels. To provide a more balanced perspective in the background
section, the authors should consider including some contrasting data regarding the prognostic
significance of low HCT levels.
3. A U-shaped relationship between HCT and all-cause mortality has been observed in the
general population. The authors could compare their findings to the study by Boffetta et al. (“A
U-shaped relationship between haematocrit and mortality in a large prospective cohort study,”
Int J Epidemiol. 2013 Apr;42(2):601-15. doi: 10.1093/ije/dyt013. PMID: 23569195; PMCID:
PMC3619954).
4. In the discussion section, the authors should attempt to explain why no significant relationship
was found between HCT and GCS/OASIS scores. Addressing this gap could strengthen the
interpretation of their results.
5. In the discussion section, the author can include a mechanistic explanation of how patients
with acute pancreatitis could develop both low and high HCT levels.
The topic has been discussed for many years; however, the novelty of the present paper is
clarifying how both extremely low and high HCT predict all-cause mortality. The authors used
robust statistical analysis and modeling in this investigation and properly discussed the debate,
application of the present study, future direction, and the study’s strengths and limitations. The
paper can merit publication after editing the mentioned comments.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 1 Date: 22 Jan 2025
Reviewer:  Lubna al#Gailani
Reviewer's report:
1. The inherent limitation of retrospective studies is acknowledged but not fully explored. The
author should include a discussion on potential biases, and how there minimized.
2. Provide a detailed account of the confounders considered and justify their inclusion.
3. Methods like LOESS regression and RCS are mentioned but not sufficiently explained for
readers unfamiliar with these techniques. The author should include brief description of these
methods in the methods section or supplementary material.
4. Expand the discussion on how the practical implication for ICU management of AP could
influence clinical practice or guidelines.
5. Simplify complex sentences and define statistical terms for broader readership.
6. Regarding the figures verify consistency between text description and visual data
representation.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 2 Date: 28 Feb 2025
Reviewer:  Amira A A Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 2 Date: 01 Mar 2025
Reviewer's report:
Given the absence of novel findings and the failure to adequately contextualize the study within
existin literature, I recommended against publication of this paper. The authors have elaborated
more in the novelty of the manuscript, explaining the merit of their paper, and changed my mind.
I recommend publication.
Review for 10.1186/s12876-025-03764-8 (2025)

Title: Association between hematocrit and mortality in critically ill patients with acute
pancreatitis: a retrospective cohort study
Version: 2 Date: 01 Mar 2025
Reviewer:  Mohammad Reza Hatamnejad
Reviewer's report:
Authors have addressed all the concerns and comments properly and the paper can be accepted
for publication.