Review for 10.1186/s12876-025-03816-z (2025)

Title: Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients
and Actual Portal Pressure Gradient
Version: 2 Date: 20 Jan 2025
Reviewer's report:
Rufeng Chen, Yaozu Liu, and colleagues demonstrated that F-HVPG and I-HVPG showed high
correlation and concordance in patients with decompensated cirrhosis. However, they stated that
when the difference between FHVP and IVCP exceeds 2 mmHg, IVCP rather than FHVP should
be used for calculating HVPG to ensure accurate assessment of the patients’ condition. While
their research is interesting and potentially beneficial to readers in terms of clinical utility, there
are several issues to be noted as follows.
Major Points:
1. The modality and measurement methods used for liver stiffness measurement should be
clearly specified.
2. The entire manuscript requires editing by a native English speaker.
3. While Groups A and B are categorized based on whether the FHVP-IVCP difference is above
or below 2 mmHg, the rationale for choosing this 2 mmHg threshold needs to be explained in
the group definition section.
4. It would be desirable to verify whether there were differences in accuracy between F-HVPG
and I-HVPG in predicting outcomes such as mortality and rebleeding events.
5. The authors cite Rössle et al. [16] to state that cases with thin hepatic veins may show falsely
elevated FHVP values, but their own study does not discuss hepatic vein diameter. To justify this
citation, the authors should analyze their own data to determine whether differences in hepatic
vein diameter affected HVPG measurements.
6. While ROC analysis is presented in the last paragraph of the Results section, it is not described
in the Statistical Analysis section and needs to be added. The phrase "For stratifying PHT of
16mmHg and 20mmHg" is unclear as to what measurement it refers to. The ROC analysis should
include AUC s with 95% confidence intervals, methods for determining optimal cutoff values
for both F-HVPG and I-HVPG, and sensitivity, specificity, PPV, and NPV at these optimal
cutoff values.
7. The current Introduction does not effectively communicate the study's purpose to readers. It
is suggested to move some content from the beginning of the Discussion to the Introduction.
Specifically, it should state  as  "While HVPG measurement is crucial in evaluating portal
hypertension, FHVP may be measured higher in cases with narrow hepatic veins, potentially
leading to underestimation of HVPG. Using IVCP instead of FHVP for HVPG measurement
could be considered, but the correlation between FHVP and IVCP has not been adequately
evaluated. Therefore, we designed this study with the aim of assessing (1) weather IVCP can
replace...," for example. Does my description align with the authors' intentions?
8. A selection bias exists as most patients underwent HVPG measurement during TIPS
procedures following gastrointestinal bleeding. The Limitations section should address whether
these findings can be applied to the baseline condition of CSPH patients and HVPG
measurement methodology in compensated cirrhosis patients.
Minor Points:
1. Please change the abbreviations used in Figures 1 and 2 to capital letters.
2. It would be desirable to indicate the years of experience of the operators who performed the
HVPG measurement technique, and if any operators are among the authors of this paper, their
initials should be provided.
3. There are noticeable inconsistencies in terminology between the main text and figures. Please
standardize the notation between HVPGfhvp and HVPGivcp in Figure 2 and F-HVPG and I-
HVPG in the main text.