Review for 10.1186/s12876-021-01614-x (2021)

Reviewer’s report
Title: 
Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of
Complicated Appendicitis.
Version: 
1 
Date: 
04 Aug 2020
Reviewer's report:
Thank you for the revision, the quality of the paper has been improved, and it
became easier to read. However, there are still some minor issues that need some
alterations.
1. Please consider putting the actual p-value, especially for the direct, indirect-,
and total bilirubin levels. To conclude that total bilirubin is the best marker for
complicated appendicitis, it should have the lessor p-value than the other two.
2. The number of tables and figures should be limited. An original article usually
allows a total of 6-10 tables and figures combined. Please confirm with the
journal about the requirement.
- When possible, please consider using only one graph or table that is the most
representative of the data—not both. For example, the comparison between the
pre-operative and post-operative bilirubin levels, using only the figure, is
sufficient, and a table can be omitted or submitted as supplementary materials.
- Some figures could be omitted from the paper, or submitted as supplementary
materials. For example, Figure 7, distribution of study population according the
serum CRP, ALT, AST, ALP or Figure 6, gender-wise duration of pain—I don't
think these are necessary and not directly correlate with the main objective.
3. The multivariate analysis provided in Table 10 is not appropriate, the better
way to do that is to have "complication" as an outcome (not a factor), and the
hyperbilirubinemia as a factor (not an outcome). This way, we can prove that
hyperbilirubinemia's ability in the prediction of complicated appendicitis was
independent and not affected by other confounders or other variables. The factors
included in the model also are supposed to be ones associated with the
complicated appendicitis (for example: pyrexia, duration of pain, appendiceal
diameter, etc).
4. Some grammartical and punctuation errors, and some typos.
5. Table 2 - Please consider adding the "male", "female", and "cumulative%"
colums to the uncomplicated appendicitis subgroups
- Also, the content in table 1, 1.1, 2, 2.1 are overlapping; the majority of the data
in the other table can be found in table 2.
- The numbers in Table 1 and Table 2 are not matched: from Table 1 there were
48 males and 27 females with simple appendicitis, and 18 males 
and 17 females with complicated appendicitis. However, Table 2 shows 15 males
and 20 females with complicated appendicitis.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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No
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Yes
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from apparent manipulation?
Yes