Quality of Evidence in Remote Monitoring of Patients With Liver Cirrhosis: A Systematic Review

BACKGROUND AND AIMS: Remote monitoring (RM) enables out-of-hospital surveillance and may benefit patients with liver cirrhosis. However, implementation in routine liver cirrhosis care is limited, most likely due to the lack of conclusive data on clinical effectiveness. This systematic review aims to analyze the quality of evidence regarding the effect of RM tools on disease outcomes for liver cirrhosis. METHODS: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review included studies of RM interventions per the World Health Organization's definition in patients with liver cirrhosis reporting at least 1 liver disease-related outcome. Retrospective or cross-sectional studies were excluded. Risk of bias was assessed using the Cochrane Risk Of Bias Tool for Randomized Trials and the Newcastle-Ottawa Scale for other study types. RM development quality was evaluated against the V3+ framework. RE-SULTS: One randomized controlled trial, 4 prospective cohorts with controls, and 7 prospective studies without controls were identified (n = 12; 636 patients; 17,680 studies screened). All studies with controls reported lower hospital readmissions in the RM groups. Interventions included smartphone applications, with or without additional measurement instruments, and automated calls. RM development quality varied substantially, with multiple RM interventions not reporting on verification (n = 6), usability (n = 4), or analytical validation (n = 5). The identified evidence informed the synthesis of a proposal framework to harmonize future RM research. CONCLUSION: Although studies show clinical benefits of RM tools in liver cirrhosis, evidence is limited by the (inherent) heterogeneity in interventions, design, and outcomes, and quality of the RM development process. This review emphasizes the need for consensus on RM monitoring frameworks and high-quality data to inform better clinical decision-making.