AASLD clinical practice guidelines: a critical review of scientific evidence and evolving recommendations.
AASLD clinical practice guidelines: a critical review of scientific evidence and evolving recommendations.
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AASLD临床实践指南：对科学证据和不断发展的建议的批判性综述。
DOI：
10.1002/hep.26578
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发表时间：
2013-12
期刊：
影响因子：
--
通讯作者：
Talwalkar JA
中科院分区：
文献类型：
--
作者：
Koh C;Zhao X;Samala N;Sakiani S;Liang TJ;Talwalkar JA
美国肝病研究协会（AASLD）实践指南提供了根据现有科学证据结合专家共识意见诊断和管理肝病患者的建议。系统地回顾AASLD指南建议的演变，并确定限制这些指南循证基础的差距。对1998年1月至2012年8月发布的初始和现行AASLD指南进行了审查。AGREE II工具用于评估指南制定的严格性和透明度。对建议的数量、等级分布（强度或确定性）、类别（获益与风险）和建议类型进行了评价。在可能的情况下，对多个版本进行了评价，以不断发展科学证据。对涉及17个专题的28项准则中的991项建议进行了评价。从最初到目前的指南，建议总数增加了36%（512至699）。增加最多的是慢性B型肝炎（HBV）（+71）、肝移植（+53）和自身免疫性肝炎（AIH）（+27）。目前大多数建议为II级（44%），不到20%为I级。AGREE II评价显示，指南质量在全球范围内有所改善。HBV和慢性丙型肝炎指南的I级推荐增加最多（分别为+383%和+67%）。治疗建议的最大增加来自HBV（I级，+1150%），肝移植（II级，+112%）和AIH（III级，+105%）。尽管随着时间的推移，AASLD实践指南中的建议数量显着增加，但只有少数得到I级证据的支持，这突出表明需要开发设计良好的调查，为不确定性领域提供证据，并提高肝胆疾病未来指南的质量。
The American Association for the Study of Liver Diseases (AASLD) practice guidelines provide recommendations in diagnosing and managing patients with liver disease from available scientific evidence in combination with expert consensus opinions. To systematically review the evolution of recommendations from AASLD guidelines and identify gaps limiting the evidence-based foundations of these guidelines. Initial and current AASLD guidelines published from January 1998 to August 2012 were reviewed. The AGREE II instrument was used to evaluate rigour and transparency of guideline development. The number of recommendations, distribution of grades (strength or certainty), classes (benefit versus risk) and types of recommendations were evaluated. Whenever possible, multiple versions were evaluated for evolving scientific evidence. A total of 991 recommendations from 28 guidelines on 17 topics were evaluated. From initial to current guidelines, the total number of recommendations increased by 36%(512 to 699). The largest increases were from chronic hepatitis B (HBV) (+71), liver transplantation (+53) and autoimmune hepatitis (AIH) (+27). Most current recommendations are grade II (44%) and less than 20% are grade I. The AGREE II evaluation showed global improvement in guideline quality. Both HBV and chronic hepatitis C guidelines had greatest increases in grade I recommendations (+383% and +67%, respectively). The greatest increases in treatment recommendations were from HBV (grade I, +1150%), liver transplantation (grade II, +112%) and AIH (grade III, +105%). Despite significant increases in the numbers of recommendations within AASLD practice guidelines over time, only a minority are supported by grade I evidence, highlighting the need for developing well-designed investigations to provide evidence for areas of uncertainty and improving the quality of future guidelines in hepatobiliary diseases.