An analysis of the evidence supporting hepatology clinical practice guidelines

Abstract

Chronic liver disease is associated with significant morbidity 1 -as such, treatment and prevention of complications is critical. In response to this critical need, committees such as the American Association for the Study of Liver Diseases (AASLD) have developed evidence-based guidelines that provide recommendations to aid clinicians in the management of these diseases. Clinical practice guidelines (CPGs) are evidence-based recommendations derived from a thorough literature review consisting of randomized control trials, meta-analyses, and systematic reviews. 2 Widely considered the gold standard of evidence in medical research, 3 systematic reviews (SR) are commonly used to summarize relevant evidence for a clinical question. 4 However, SRs are not without criticism. To address these concerns, several tools have been developed to critically appraise the reporting and quality of SRs. Two well-known tools for grading the quality of SRs are AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) and PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses).Both systems are developed by epidemiology experts that rely on a checklist of items considered to be essential to providing a strong, evidence-based SR with low risk of bias. Here, we used AMSTAR-2 and PRISMA instruments to evaluate the quality of SRs cited as evidence in the AASLD CPGs. METHODSThis study conducted all analyses in parallel by blinded investigators (D.N. and A.R.) to ensure transparent and reproducible study results. Our preregistered protocol can be found online. 5 Our primary objective was to critically appraise the reporting and quality of SRs underlying CPG recommendations for the management of the liver disease. Our secondary objectives were to quantify the number of Cochrane SRs cited by these CPGs and to evaluate the difference in reporting and quality measures between Cochrane and non-Cochrane SRs using scoring systems based on criteria for the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) and PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses). We used CPGs published by AASLD (https://www.aasld.org/publications/ practice-guidelines). Using the definition of CPG by the Institute ofMedicine, 2 we identified and screened CPGs for inclusion using all of the following criteria: (1) the CPG was for the management of liver dis-