An analysis of the evidence supporting hepatology clinical practice guidelines

Chronic liver disease is associatedwith significantmorbidity1—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 (AMeasurementTool toAssessSystematicReviews2) andPRISMA(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 SRwith low risk of bias. Here, we used AMSTAR-2 and PRISMA instruments to evaluate the quality of SRs cited as evidence in the AASLDCPGs.