Review for 10.1186/s12876-020-01448-z (2020)

Reviewer’ s report
Title: Extra-Hepatic Comorbidity Burden Significantly Increases 90-day Mortality in Patients
with Cirrhosis and High Model for Endstage Liver Disease
Version: 0Date: 01 Sep 2020
Reviewer's report:
The Authors analyze a population of cirrhotics, evaluated for LT, in regards of the increased risk of
90d mortality due to their burden of comorbidities.The methods are sound and the results presented systematically and in a comprehensive way.The Authors observed that CCI score - as well as CirCom - seem to perform well in predictingmortality in patients with worsening liver function. The final message is of limited novelty but yetit is interesting to corroborate previous evidence on the topic.In addition to the 90d outcome, the reporting of long-term follow-up makes it interesting to gatherinformation about what happened to those patients initially evaluated for LT.
My minor reservations:
- As the study population is characterized by patients who were evaluated for LT, it'd be useful toknow how many patients were eventually listed and how many dropped out of the waitlist due toworsening clinical status and if this was influenced by the comorbidity burden.- In results: "The median follow-up in 54 patients alive without LT was 6 years (IQR 0.6, 6.5)".Isn't the lower value of the IQR too small? If these are the surviving patients and they all belong toyear 2012, is there a proportion of patients who should be considered as lost to follow-up insteadof "alive without transplant"?- In table 1: the proportion of patients with fatty liver disease seems too small (2% ?).
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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?
YesAre the methods sufficiently described to allow the study to be repeated?Yes
Is the use of statistics and treatment of uncertainties appropriate?
YesIs the presentation of the work clear?YesAre the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes