Review for 10.1186/s12876-020-01413-w (2020)

Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 07 May 2020
Reviewer's report:
The authors compare conventional coagulation tests (CCTs) versus point of care testing (ROTEM)
in 55 compensated cirrhotic patients and 22 patients with ACLF.
Major points
1.Utility of ROTEM in non ACLF (compensated cirrhosis) patientsIt is established clinical practice not to correct platelets or INR based on CCTs in compensatedcirrhotic patients. Various components of ROTEM like maximum clot firmness, A10 min, αangle,
lysis etc. would be normal in most such patients. What would be the indication to do ROTEM inthis set of patients?
2.Timing of ROTEM in ACLF patients
Expectedly patients with ACLF are sicker and have significantly higher infections, organ failureand mortality. Their state of 'balanced coagulation' is altered with more bleeding episodes.ROTEM therefore shows corresponding abnormalities. Since ACLF is a dynamic state withrapidly changing clinical condition, ROTEM would give a snapshot of the current coagulationstate. When do the authors recommend doing ROTEM in ACLF patients? At what time point/swas it done in this study? In patients with bleeding was ROTEM done after the bleeding episode todecide which components to correct? Are the authors suggesting that ROTEM indices (MCF or
A10) can be used to predict a bleed in ALCF and preemptive correction given?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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