Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

They selected references within their field of expertise and experience and graded the references according to the GRADE system. 1 The selection of references for the guideline was based on a validation of the appropriateness of the study design for the stated purpose, a relevant number of patients under study, and confidence in the participating centers and authors.References on original data were preferred and those that were found unsatisfactory in any of these respects were excluded from further evaluation.There may be limitations in this approach when recommendations are needed on rare problems or problems on which scant original data are available.In such cases, it may be necessary to rely on less-qualified references with a low grading.As a result of the important changes in the treatment of complications of cirrhosis (renal failure, infections, and variceal bleeding [VB]), studies performed more than 30 years ago have generally not been considered for these guidelines. Recommendation StrongFactors influencing the strength of recommendation included the quality of evidence, presumed patient-important outcomes, and costs. 1 Weak Variability in preferences and values, or more uncertainty.Recommendation is made with less certainty, higher costs, or resource consumption.