Table 5.

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

Certainty assessment							Impact	Certainty	Importance
Number of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations
Levels of TNF-a in adult patients
3	observational studies	not serious	not serious	not serious	not serious	none	In 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
4	observational studies	not serious	not serious	not serious	not serious	none	In 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