Review for 10.1186/s12876-025-04095-4 (2025)

Title: Long-term Quality of Life After Acute Pancreatitis: A Systematic Review and Meta-
Analysis
Version: 0 Date: 25 Feb 2025
Reviewer:  Sheza Malik
Reviewer's report:
Title: Quality of Life After Acute Pancreatitis: A Systematic Review and Meta-Analysis
Authors: Dongming Xu, Chang Liu, Jie Zhou
General Assessment
The manuscript is well-structured, methodologically sound, and follows PRISMA guidelines.
The systematic review and meta-analysis provide valuable insights into an underexplored area
in gastroenterology. However, some areas require revision for improved clarity, transparency,
and scientific rigor.
Comments
1. Overstatement of Conclusions
The conclusion suggests that AP potentially compromises” QoL in the long term. However,
given the heterogeneous findings—where only physical health domains show significant
impairment while mental health remains unaffected—the conclusion should be refined.
Recommendation:
Modify the conclusion to state that while physical health is significantly impaired, mental and
social aspects do not exhibit consistent deterioration.
Explicitly highlight study limitations, including variability in QoL assessment tools and patient
severity classification.
2. Addition of PICO in Methods
The methodology lacks a structured PICO (Population, Intervention, Comparison, Outcome)
framework, which would improve clarity.
Recommendation:
Add a PICO framework to define the study structure clearly:
3. Newcastle-Ottawa Scale (NOS) Reference
The study uses the Newcastle-Ottawa Scale (NOS) for quality assessment but does not cite a
reference for this tool.
Recommendation:
Add a proper reference for the NOS scoring system (e.g., Stang A. Critical evaluation of the
Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-
analyses. Eur J Epidemiol. 2010;25(9):603-605. doi:10.1007/s10654-010-9491.).
4. Statistical Analysis - Missing References
The statistical methods follow Cochrane Collaboration guidelines but lack appropriate citations.
Recommendation:
Provide references for meta-analysis methodologies, particularly in calculating pooled mean
differences (MD) and handling heterogeneity.
5. Study Proportions for Better Understanding
In the results, the manuscript states:
"The study included 76 AP patients and 15 SAP patients out of a total of 91 participants."
Recommendation:
Add proportions for clarity:
6. Adding Reference Numbers in Tables
Tables summarizing the study characteristics and results should include reference numbers for
each included study to improve traceability.
Recommendation:
In Table 1 and Table 2, add reference numbers corresponding to each included study.
7. Heterogeneity and QoL Tools
The discussion should further elaborate on the impact of using different QoL assessment tools
(SF-36, SF-12) and how this contributes to heterogeneity.
Recommendation:
Discuss whether SF-36 and SF-12 measure similar aspects of QoL or if discrepancies in scoring
may explain inconsistencies across studies.
Highlight the need for a standardized pancreatitis-specific QoL tool, such as GIQLI or PAN-
PROMISE, to improve consistency in future studies.
8. Restructuring the Discussion for Better Flow
Currently, the discussion begins with background information before summarizing the results.
This makes it harder to follow the key findings.
Recommendation:
Restructure the first paragraph of the discussion to summarize the key results before moving
into interpretation. Suggested structure:
Summary of Findings: AP patients show significant impairment in physical health (role physical,
general health, vitality), while mental health scores remain unchanged.
Comparison with Previous Studies: Discuss how the findings align with or diverge from prior
meta-analyses.
Heterogeneity and Limitations: Address methodological variations and limitations of included
studies.
Future Research Needs: Emphasize the need for standardized QoL measurement tools and larger,
prospective studies.
Final Recommendation
Decision: Accept after Minor Revision