Zinc supplementation in patients with cirrhosis and hepatic encephalopathy: a systematic review and meta-analysis

Nutrition Journal

Table 2 GRADE assessment of the outcomes

Certainty assessment							№ of patients	Effect		Certainty
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Zn	Placebo	Absolute (95% CI)	Certainty
Number connection test
3	randomized trials	serious^a	not serious	not serious	not serious	publication bias strongly suspected strong association^b	116	111	SMD 0.97 lower (1.75 lower to 0.19 lower)	MODERATE
Digital symbol test
2	randomized trials	serious^a	not serious	not serious	serious^c	publication bias strongly suspected strong association^b	70	67	SMD 0.44 higher (0.12 lower to 1 higher)	VERY LOW
Serum ammonia lev
2	randomized trials	serious^a	not serious	not serious	serious^c	publication bias strongly suspected strong association^b	70	67	MD 10.86 lower (25.73 lower to 4.01 higher)	VERY LOW

CI Confidence interval, SMD Standardized mean difference, MD Mean difference
Explanations
^aWe downgraded by one level for serious risk of bias: one study was unblinded
^bPublication bias was not assessed due to the limited numbers of included trials
^cWe downgraded by one level for serious imprecision: the wide confidence interval contains significant benefits and harm

ISSN: 1475-2891