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: 08 May 2020
Reviewer's report:
The authors attempt to address the differences in haemostasis evaluation employing conventional
coagulations tests and ROTEM in ACLF and non-ACLF cirrhotic patients. They describesignificant differences that suggest the superiority of a viscoelastic test over CCT. This findingcould have signicant clinical implications.Several minor comments can be made to improve the manuscript.1.The authors compare patients with ACLF and those without. However, this Last group seemsunhomogeneous considering that some of the patients included had elective hospitalizations(TACE) while the others had non-ACLF acute decompensations. This fact difficult theinterpretation the findings of the study even more considering that patients considered fit to TACEcommonly have compensated cirrhosis. Please discuss.2.It would be very useful for the non-expert hepatologyst to explain why different tests arerequires to perform a proper ROTEM evaluation.3.The cause of hospitalization must be described on each group.4.Only 77 patients were included in the study (22 of them had ACLF). Thus, non-parametric testshould be employed to perform comparisons between groups and the variables must be expressedas median and IQR. At this respect special attention must be pay to the comparison between thoseACLF who bleed and those who did not.5.Line 210 (section 3.3): "the Non-ACLF group showed a significantly CT and higher MCF
compared to ACLF patients". It seems to me that in should say: "…showed a CT and MCF
significantly increased compared to ACLF patients"6.I recommend a title that stated better the most important findings of the study. Probablysomething similar to: "Rotational thrombelastometry (ROTEM) improves hemostasis assessmentcompared to conventional coagulation test in ACLF and non-ACLF patients".7.An additional table showing the results of the multivariate analysis of survival (OR and CI) mustbe added.8.The meaning of "POC test" (point of care test?) was not specified.9.The study of Kumar et al can be cited in the discussion section to reinforce the concept thatviscoelastic tests seems to be superior to conventional tests to evaluate the risk of bleeding and toguide the rational administration of hemoderivatives (doi: 10.1002/hep.30794).
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does 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:
AcceptableDeclaration of competing interests
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