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Table 2 Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profile

From: Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Quality assessment No. of patients Effect Quality
No. of studies Risk of bias Inconsistency Indirectness Imprecision Other considerations Omega-3 supplementation Control Relative (95% CI) Absolute (95% CI)
Mortality
 17 Not serious Not serious Seriousa Not seriousb None 149/629 (23.7%) 161/610 (26.4%) RR 0.85 (0.71 to 1.03) 40 fewer per 1000 (from 8 more to 77 fewer) Moderate
ICU length of stay
 12 Seriousc Seriousd Seriousa Not serious None 469 456 MD 3.79 days fewer (5.49 fewer to 2.09 fewer) Very low
Duration of mechanical ventilation
 7 Seriousc Seriouse Seriousa Not serious None 254 241 MD 2.27 days fewer (4.27 fewer to 0.27 fewer) Very low
  1. CI confidence interval, RR relative risk, MD mean difference
  2. aWe rated down the quality of evidence by one level for multiple sources of indirectness. Population: mechanical ventilation and sepsis severity varied as inclusion criteria across studies. Intervention: content of enteral/parenteral formulations differed across studies (10 used fish oil alone while 7 used formulae with additional supplements such as mRNA, arginine, and selenium). Outcome: different mortality definitions (28-day, 60-day, in-hospital, ICU)
  3. bWe did not rate down the quality of evidence for imprecision. The CI included both significant benefit and small harm, but the number of events was not small
  4. cWe rated down the quality of evidence by one level for risk of bias. Several studies showed high risk of attrition bias and performance bias
  5. dWe rated down the quality of evidence by one level for significant unexplained heterogeneity (P < 0.00001, I 2 = 82%)
  6. eWe rated down the quality of evidence by one level for significant unexplained heterogeneity (P = 0.02, I 2 = 60%)