• Xia Wang, Meng-Yao Zheng, Hai-Yu He, Hui-Ling Zhu, Ya-Fang Zhao, Yu-Hang Chen, Zhi-Yuan Xu, Jin-Hui Yang, and Da-Li Sun.
• Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University, Kunming, China.
• Crit. Care Med. 2024 Oct 1; 52 (10): 162416321624-1632.

ObjectivesThis study aimed to systematically assess the methodological quality and key recommendations of the guidelines for the diagnosis and treatment of liver failure (LF), furnishing constructive insights for guideline developers and equipping clinicians with evidence-based information to facilitate informed decision-making.Data SourcesElectronic databases and manual searches from January 2011 to August 2023.Study SelectionTwo reviewers independently screened titles and abstracts, then full texts for eligibility. Fourteen guidelines were included.Data Extraction And SynthesisTwo reviewers extracted data and checked by two others. Methodological quality of the guidelines was appraised using the Appraisal of Guidelines for Research and Evaluation II tool. Of the 14 guidelines, only the guidelines established by the Society of Critical Care Medicine and the American College of Gastroenterology (2023) achieved an aggregate quality score exceeding 60%, thereby meriting clinical recommendations. It emerged that there remains ample room for enhancement in the quality of the guidelines, particularly within the domains of stakeholder engagement, rigor, and applicability. Furthermore, an in-depth scrutiny of common recommendations and supporting evidence drawn from the 10 adult LF guidelines unveiled several key issues: controversy exists in the recommendation, the absence of supporting evidence and confusing use of evidence for recommendations, and a preference in evidence selection.ConclusionsThere are high differences in methodological quality and recommendations among LF guidelines. Improving these existing problems and controversies will benefit existing clinical practice and will be an effective way for developers to upgrade the guidelines.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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