The Prognostic Significance of Uric Acid/Albumin Ratio in Patients with Aortic Stenosis Following Transcatheter Aortic Valve Implantation for Major Adverse Cardiac and Cerebral Events
Round 1
Reviewer 1 Report
I think you did a great job, because a very simple, feasible method, which has already been shown to be an excellent inflammatory marker, is implicated in the development of complications in the postoperative period of TAVI, mainly because this is a group of elderly patients and debilitated, with countless other co-morbidities. The limitations of the study are all there. Now we need prospective and randomized clinical studies to validate the method and experimental studies to study the mechanisms involved in developing aortic stenosis.
You need to correct some words. Acid uric in some places was written asid uric. You forgot to put + and - between the age and variation in the first line of the results.
Author Response
Response to Reviewer 1 Comments
Point-1 I think you did a great job, because a very simple, feasible method, which has already been shown to be an excellent inflammatory marker, is implicated in the development of complications in the postoperative period of TAVI, mainly because this is a group of elderly patients and debilitated, with countless other co-morbidities. The limitations of the study are all there. Now we need prospective and randomized clinical studies to validate the method and experimental studies to study the mechanisms involved in developing aortic stenosis.
You need to correct some words. Acid uric in some places was written asid uric. You forgot to put + and - between the age and variation in the first line of the results.
Response-1
Dear rewiever, we thank you for the evaluations, we have corrected the related typos.
Author Response File: 
Author Response.docx
Reviewer 2 Report
As authors mentioned in manuscript, this is first analysis of prognostic value of uric acid to albumin ratio (UAR) in patients who under went TAVI.
The UAR was reported as a prognostic marker for acute kidney injury, acute coronary syndrome, etc.
So, it is not a novel marker for predicting cardiac outcomes in various disease condition.
Authors may describe more clearly that the reason why UAR was selected for this study.
It would be better to briefly summarize the recent studies that describe the role of UAR as a prognostic marker in discussion.
High uric acid and low albumin are also marker for frailty of elderly patients and it may also need to mentioned in discussion.
Author Response
Response to Reviewer 1 Comments
Point-1 I think you did a great job, because a very simple, feasible method, which has already been shown to be an excellent inflammatory marker, is implicated in the development of complications in the postoperative period of TAVI, mainly because this is a group of elderly patients and debilitated, with countless other co-morbidities. The limitations of the study are all there. Now we need prospective and randomized clinical studies to validate the method and experimental studies to study the mechanisms involved in developing aortic stenosis.
You need to correct some words. Acid uric in some places was written asid uric. You forgot to put + and - between the age and variation in the first line of the results.
Response-1
Dear rewiever, we thank you for the evaluations, we have corrected the related typos.
Author Response File: Author Response.docx
Reviewer 3 Report
The authors reported that higher uric acid/albumin ratio carried higher MACCEs in AS patients who received TAVI under a retrospective study of 150 patients. However, as we all know that elevated serum UA levels are detrimental to the cardiovascular system and lipid metabolism, it is not surprising that the higher uric acid level is related to higher MACCE. Besides, lower albumin level also implies poor nutrition status and/or poorer liver function, which is reasonable to cause higher MACCE. Therefore, though the study proved that UAR's predictive value for increased mortality after TAVI, it showed nothing innovatively.
Furthermore, there are a lot of misspelling and mistakes in the article. The "uric acid" was misspelled into "uric asid" for many times. And, in the Table 1, the number and ratio in gender and hypertension showed obviously some mistakes. Besides, the mean age is 77y/o in the no MACCE group, and 77.1 y/o in the MACCE group, but 78y/o in all patients? It's not reasonable.
Author Response
Response to Reviewer 3 CommentsPoint-1The authors reported that higher uric acid/albumin ratio carried higher MACCEs in AS patients who received TAVI under a retrospective study of 150 patients. However, as we all know that elevated serum UA levels are detrimental to the cardiovascular system and lipid metabolism, it is not surprising that the higher uric acid level is related to higher MACCE. Besides, lower albumin level also implies poor nutrition status and/or poorer liver function, which is reasonable to cause higher MACCE. Therefore, though the study proved that UAR's predictive value for increased mortality after TAVI, it showed nothing innovatively. Response 1-As stated by the referee, while we can predict that high UA and low albumin levels may be associated with the increase in MACCE, we thought that it would be the first evaluation and confirmatory study in this field, since there has been no study in the literature with UAR in patients who have undergone TAVI. Point-2 Furthermore, there are a lot of misspelling and mistakes in the article. The "uric acid" was misspelled into "uric asid" for many times. And, in the Table 1, the number and ratio in gender and hypertension showed obviously some mistakes. Besides, the mean age is 77y/o in the no MACCE group, and 77.1 y/o in the MACCE group, but 78y/o in all patients? It's not reasonable
Response 2-We fixed the mentioned typos and statistical errors
Author Response File: Author Response.docx
Round 2
Reviewer 3 Report
The authors corrected the typo errors. However, I still think that though the study proved the relationship between UAR value and mortality after TAVI, it showed nothing innovatively. As Table 3, the value of CRP is also an independent factor for mortality after TAVI. Either CRP, WBC, uric acid or albumin, can reflect the inflammatory or nutritional status. Therefore, it is not surprising that UAR data is higher in the MACCE group than the non-MACCE group.
Author Response
First of all, thank you for your review, dear reviewer.
As we mentioned before, we wanted to evaluate the uric acid albumin ratio because it has antioxidant properties, reflects the inflammatory state, and is easily obtainable markers. Although there are studies conducted with the initial CRP level and also with the CRP/Albumin ratio, we think that it will be meaningful since it has not been examined in patients who have undergone TAVI before. In addition, infections, chronic diseases, etc., which also affect the initial CRP level. can create conflicts
King regards
