Review for 10.1186/1471-230X-10-40 (2010)

Reviewer's report
Title:Prevalence of liver fibrosis and risk factors in a general population using
non-invasive biomarkers (FibroTest)
Version: 1Date:15 March 2010
Reviewer: Guillaume PENARANDA
Reviewer's report:
Poynard T. et al. aim was to use FT as a first-line test and elastography as a
confirmation test in order to estimate the prevalence of advanced fibrosis in a
general population. They also suggested to identify independent risk factors of
fibrosis and to compare the accuracy of a non-selective screening versus
selective screening. They concluded that biomarkers permitted to estimate a
prevalence of advanced fibrosis of 2.8% in a general population of 40 years or
older, and they found several risk factors for selective screening versus
non-selective screening.
The manuscript is well written, and authors answered to it aims. The study is of
interest in the field of non-invasive markers of fibrosis, as the authors performed
a study on the prevalence of liver fibrosis without using invasive liver biopsy.
I recommend publication of this manuscript, but I request some Minor Essential
Revisions that could benefit the manuscript.
Minor Essential Revisions
1- Results “Screened population”: Last sentence – Authors reported that included
population was not different from French population (Table S2) but there is no
way to compare each other. I suggest to p-values or 95%CI in Table S2.
2- Results “Prevalence of Fibrosis”: I suggest homogenizing the reported results
in the first sentence: 209 (2.8%; 95%CI 2.4%-3.2%) had FT […] 25 (0.3%; 95%CI
0.2%-0.5%) had presumed cirrhosis […] 42 (20%; 95%CI…) had steatotest […]
N (1%; 95%CI…) had NashTest. Authors should report results as N (%; 95%CI)
when appropriate all along the manuscript
3- Table 1: Same remark; I suggest homogenizing the reported results by adding
95%CI for each parameters, as it is done for Carbohydrate Deficient Transferin
or even LSM.
4- There are too many tables. I suggest deleting some of them that are not
mandatory. Table S1: merge with Table 1. Table S5: Seems not mandatory.
5- Table S4: Shouldn’t we read “cirrhosis” instead of “fibrosis” all along the Table
? If not, than the last sentence of “Prevalence of Fibrosis” section should state
“Fibrosis” instead of “Cirrhosis”
6- Factors associated with fibrosis: Table 1 should not be cited as it gives no
additional information for univariate analysis.
7- Last paragraph of Results section – 1st sentence: typo LCM à LSM
8- Discussion “Prevalence of advanced liver fibrosis”: last paragraph – delete
“was” from “permitted to was attribute”
Discretionary Revisions
1- Discussion: 1st sentence should be deleted. It’s not a very good way to begin
a discussion with limitations of the study.
2- Tables S6 and S7 should not be supporting tables, but Table 6 and Table 7 as
well. These tables are of importance.
3- I suggest reporting page numbers, or at least line numbers.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that i have no competing interests