Review for 10.1186/s12876-024-03584-2 (2025)

Title: Association of pan-immune-inflammatory value with metabolic dysfunction-associated
steatotic liver disease: findings from NHANES 2017-2020
Version: 0 Date: 30 Nov 2024
Reviewer:  Ehsan Amini-Salehi
Reviewer's report:
ear Editor,
Thank you for inviting me to review the manuscript titled "Association of Pan-Immune-
Inflammatory Value with Metabolic Dysfunction-Associated Steatotic Liver Disease: Findings
from NHANES 2017-2020." This study explores the association between the pan-immune-
inflammatory value (PIV) and metabolic dysfunction-associated steatotic liver disease
(MASLD), leveraging NHANES data from 2017 to 2020. The investigation is timely and
clinically relevant, particularly given the growing recognition of inflammation's role in MASLD
pathophysiology. Below are my detailed comments.
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General Comments
1. Title and Abstract:
o The title accurately reflects the study's scope and content. The abstract provides a clear
summary but would benefit from explicitly stating the study's cross-sectional design as a
limitation.
2. Introduction:
o The introduction is well-written and provides a solid rationale for the study. However, a brief
discussion of how PIV compares to other biomarkers in MASLD prediction would strengthen
the background.
3. Language and Readability:
o The manuscript is well-written overall but contains minor grammatical errors. For instance,
some sentences in the results and discussion sections are overly complex and could be simplified.
4. Figures and Tables:
o The figures and tables are informative and visually clear. However, more detailed legends
would enhance their standalone utility for readers unfamiliar with PIV.
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Clinical Comments
1. Relevance to Practice:
o The manuscript highlights PIV's potential as a MASLD biomarker but does not address its
practical application in clinical settings, such as cutoff values for risk stratification.
2. Comorbidities:
o While the authors control for cardiometabolic comorbidities, a more in-depth discussion on
how these conditions interact with PIV and MASLD would enhance clinical relevance.
3. Nonlinear Relationship:
o The discussion mentions the nonlinear relationship between PIV and MASLD but does not
elaborate on its implications for biomarker interpretation in clinical practice.
4. Screening Implications:
o Given the study's findings, a discussion on integrating PIV into existing MASLD screening
algorithms, alongside liver ultrasound and other biomarkers, would be beneficial.
5. Population-Specific Findings:
o The manuscript should emphasize whether the findings apply broadly to diverse populations
or are limited by the demographic characteristics of the NHANES sample.
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Statistical Comments
1. Heterogeneity:
o The authors conducted stratified analyses but should discuss whether heterogeneity exists
within specific subgroups, such as age or race/ethnicity.
2. Sensitivity Analysis:
o The sensitivity analyses are robust but require more detailed discussion in the results section
to reassure readers about the consistency of findings.
3. Model Selection:
o The manuscript uses three models with varying levels of adjustment. Explaining the rationale
for including specific covariates in each model would clarify their interpretation.
4. Nonlinear Trends:
o The restricted cubic spline analysis is appropriate. However, discussing its implications for
interpreting the ORs across the PIV spectrum would strengthen the results section.
5. Limitations of NHANES Data:
o NHANES data, while comprehensive, has inherent limitations, such as reliance on self-
reported information and selection biases. These should be addressed in the discussion.