Clinical practice guidelines recommendations compared to the findings of the Cochrane systematic reviews on the management of decompensated liver cirrhosis in the USA and Europe

Abstract

Background Clinical practice guidelines (CPGs) contain recommendations intended to aid clinicians in providing optimal care for patients and should be derived from the best quality evidence available. This exploratory study aimed to determine the proportion of guideline statements from major liver organisations in the USA and Europe that concurred with the conclusions of Cochrane systematic reviews. Methods We selected four topics related to decompensated cirrhosis on which our group has recently published seven Cochrane systematic reviews (variceal bleeding, spontaneous bacterial peritonitis, ascites, hepatorenal syndrome). We performed a purposive sample of CPGs from leading organisations covering these topics until January 2022. For each guideline recommendation statement, two researchers independently assessed whether there was agreement in the statement and the strength of recommendation given by guideline authors when compared with those derived from the Cochrane reviews. We meta-analysed the proportion of agreement using R using the ‘Generalised Linear Mixed Model’ method for meta-analysis of proportions. Results We identified nine CPGs covering the four topics which contained 62 guideline statements that were also covered in seven Cochrane reviews. Agreement between the guideline authors and independent assessment was 14.5% (95% CI 7.7% to 25.6%). Most disagreements related to the strength of recommendation given: the guideline authors overstated the strength of recommendation. These disagreements could not be explained by the difference in the search dates between the guidelines and Cochrane reviews. Conclusion Our findings suggest a systematic issue with guideline developers overstating the strength of recommendations, which has the potential for direct impact on patient care.

The authors' abstract, as published at the source. Frontline Gastroenterology, 2026 · DOI ↗