Assessment of the Quality of Evidence Underlying International Guidelines in Liver Disease

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OBJECTIVE:We aimed to describe the overall quality of evidence supporting international guidelines in liver disease.METHODS:The quality of evidence supporting guidelines from three international liver disease associations was graded as high, moderate, or low according to the systems initially used to assess the primary literature.RESULTS:Twenty-three current guidelines were developed with the use of five evidence-grading systems. Evidence was assessed as low-quality (from consensus opinions) in 43.9% of all recommendations. Recommendations based on high-quality evidence (from consistent data from randomized controlled trials) appeared least frequently. Where guidelines had been updated, there was a 22% increase in the total number of recommendations, due largely to an increase in recommendations based on low-quality evidence. Recommendations revised to include high-quality evidence accounted for only 16.3% of all new or updated recommendations.CONCLUSIONS:Guidelines in liver disease are heterogeneous. Evidence-based recommendations in these guidelines are most frequently based on low-quality evidence.

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