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Table 2 GRADE assessment of the outcomes

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

Certainty assessment № of patients Effect Certainty
No. of studies Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations Zn Placebo Absolute (95% CI)
Number connection test
 3 randomized trials seriousa not serious not serious not serious publication bias strongly suspected strong associationb 116 111 SMD 0.97 lower (1.75 lower to 0.19 lower) MODERATE
Digital symbol test
 2 randomized trials seriousa not serious not serious seriousc publication bias strongly suspected strong associationb 70 67 SMD 0.44 higher (0.12 lower to 1 higher) VERY LOW
Serum ammonia lev
 2 randomized trials seriousa not serious not serious seriousc publication bias strongly suspected strong associationb 70 67 MD 10.86 lower (25.73 lower to 4.01 higher) VERY LOW
  1. CI Confidence interval, SMD Standardized mean difference, MD Mean difference
  2. Explanations
  3. aWe downgraded by one level for serious risk of bias: one study was unblinded
  4. bPublication bias was not assessed due to the limited numbers of included trials
  5. cWe downgraded by one level for serious imprecision: the wide confidence interval contains significant benefits and harm