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Table 5 Grading of recommendation, assessment, development, and evaluation (GRADE) instrument

From: Association of cerebral malaria and TNF-α levels: a systematic review

Certainty assessmentImpactCertaintyImportance
Number of studiesStudy designRisk of biasInconsistencyIndirectnessImprecisionOther considerations
Levels of TNF-a in adult patients
 3observational studiesnot seriousnot seriousnot seriousnot seriousnoneIn three studies, 80 patients with cerebral malaria and 40 patients with severe malaria were evaluated. The mean TNF alpha level was significantly higher in cerebral malaria than in severe malaria in all evaluated studies. The mean levels of TNF alpha level varied from 52.40 to 53.26 pg/ml in the cerebral malaria group. No information was reported among means of TNF alpha level in severe malaria group.
LOW
CRITICAL
Levels of TNF-a in children patients
 4observational studiesnot seriousnot seriousnot seriousnot seriousnoneIn four studies, 98 patients with cerebral malaria and 101 patients with severe malaria were evaluated. The mean of TNF alpha level, as well as the immunoexpression reported by one study, were significantly higher in cerebral malaria when compared to severe malaria in the evaluated studies. No information was reported among means of TNF alpha level in both groups.
LOW
CRITICAL