Determinants of re‐compensation in patients with hepatitis B virus‐related decompensated cirrhosis starting antiviral therapy
Summary Background Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)‐related decompensated cirrhosis. Aim To establish a prognostic model to predict re‐compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy Methods We ana...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2022-01, Vol.55 (1), p.83-96 |
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| creator | Kim, Tae Hyung Um, Soon Ho Lee, Young‐Sun Yim, Sun Young Jung, Young Kul Seo, Yeon Seok Kim, Ji Hoon An, Hyunggin Yim, Hyung Joon Yeon, Jong Eun Byun, Kwan Soo |
| description | Summary
Background
Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)‐related decompensated cirrhosis.
Aim
To establish a prognostic model to predict re‐compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy
Methods
We analysed 311 consecutive patients with HBV‐related decompensated cirrhosis treated with entecavir or tenofovir. The primary outcome was re‐compensation, defined as recovery to a Child–Pugh score of 5. The BC2AID score was developed from a cohort of 152 subjects based on competing risk models and validated in another cohort of 159 subjects.
Results
Re‐compensation occurred in 57.2% and 66.7% of the subjects in the derivation and validation cohorts, respectively. Six independent predictors for re‐compensation were identified in the derivation cohort and these comprised the BC2AID score: bilirubin ≤5 mg/dL (adjusted sub‐distribution hazard ratio [aSHR] 2.18), absence of severe complications (aSHR 2.78), alpha‐fetoprotein (AFP) ≥50 ng/mL (aSHR 2.54), alanine aminotransferase ≥200 IU/L (aSHR 2.62), international normalised ratio ≤1.5 (aSHR 2.37) and ≤6 months from initial decompensation until initiation of NUCs (aSHR 4.79). In the validation cohort, the area under the receiver operating characteristic curve of the BC2AID score for re‐compensation within 1 year of NUC therapy was significantly higher than that of the Child–Pugh, MELD, MELDNa and BE3A scores (0.813 vs 0.691, 0.638, 0.645 and 0.624, respectively; all P |
| doi_str_mv | 10.1111/apt.16658 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2583448743</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2583448743</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3538-564926da9aeabeca5dd0aad6e4724bdf949f2394c5425e65f8864e9fc40d02343</originalsourceid><addsrcrecordid>eNp1kctKBDEQRYMoOj4W_oAE3OiiNe_pXvpWEHSh65DpVDuRfpmkldnpH_iNfokZR10I1qaq4NxbBRehbUoOaKpD08cDqpTMl9CIciUzRrhaRiPCVJGxnPI1tB7CIyFEjQlbRWtcKMUEVyP0dgoRfONa08aAuwp7-Hh9L7umhzaY6LoWuxb3aYI58OLiFE9hvkcX8DF-dn4ISeGhNhEstvCrTVvpvJ92IZEhGh9d-4DTHZdEpsZxCt70s020Upk6wNZ330D352d3J5fZ9c3F1cnRdVZyyfNMKlEwZU1hwEygNNJaYoxVIMZMTGxViKJivBClFEyCklWeKwFFVQpiCeOCb6C9hW_vu6cBQtSNCyXUtWmhG4JmMudC5GPBE7r7B33sBt-m7zRTNKcFHUuVqP0FVfouBA-V7r1rjJ9pSvQ8F51y0V-5JHbn23GYNGB_yZ8gEnC4AF5cDbP_nfTR7d3C8hO4epwh</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2618191756</pqid></control><display><type>article</type><title>Determinants of re‐compensation in patients with hepatitis B virus‐related decompensated cirrhosis starting antiviral therapy</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Kim, Tae Hyung ; Um, Soon Ho ; Lee, Young‐Sun ; Yim, Sun Young ; Jung, Young Kul ; Seo, Yeon Seok ; Kim, Ji Hoon ; An, Hyunggin ; Yim, Hyung Joon ; Yeon, Jong Eun ; Byun, Kwan Soo</creator><creatorcontrib>Kim, Tae Hyung ; Um, Soon Ho ; Lee, Young‐Sun ; Yim, Sun Young ; Jung, Young Kul ; Seo, Yeon Seok ; Kim, Ji Hoon ; An, Hyunggin ; Yim, Hyung Joon ; Yeon, Jong Eun ; Byun, Kwan Soo</creatorcontrib><description>Summary
Background
Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)‐related decompensated cirrhosis.
Aim
To establish a prognostic model to predict re‐compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy
Methods
We analysed 311 consecutive patients with HBV‐related decompensated cirrhosis treated with entecavir or tenofovir. The primary outcome was re‐compensation, defined as recovery to a Child–Pugh score of 5. The BC2AID score was developed from a cohort of 152 subjects based on competing risk models and validated in another cohort of 159 subjects.
Results
Re‐compensation occurred in 57.2% and 66.7% of the subjects in the derivation and validation cohorts, respectively. Six independent predictors for re‐compensation were identified in the derivation cohort and these comprised the BC2AID score: bilirubin ≤5 mg/dL (adjusted sub‐distribution hazard ratio [aSHR] 2.18), absence of severe complications (aSHR 2.78), alpha‐fetoprotein (AFP) ≥50 ng/mL (aSHR 2.54), alanine aminotransferase ≥200 IU/L (aSHR 2.62), international normalised ratio ≤1.5 (aSHR 2.37) and ≤6 months from initial decompensation until initiation of NUCs (aSHR 4.79). In the validation cohort, the area under the receiver operating characteristic curve of the BC2AID score for re‐compensation within 1 year of NUC therapy was significantly higher than that of the Child–Pugh, MELD, MELDNa and BE3A scores (0.813 vs 0.691, 0.638, 0.645 and 0.624, respectively; all P < 0.05).
Conclusions
Six clinical parameters, including AFP and the timing of antiviral therapy, were combined into a scoring system to accurately predict early re‐compensation in patients with HBV‐related decompensated cirrhosis.
The new model consisting of six factors was established to predict re‐compensation of patients with HBV‐related decompensated cirrhosis. It stratified the survival and re‐compensation well.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.16658</identifier><identifier>PMID: 34662436</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Alanine ; Alanine transaminase ; Antiviral agents ; Antiviral Agents - therapeutic use ; Bilirubin ; Cirrhosis ; Hepatitis B ; Hepatitis B - drug therapy ; Hepatitis B virus ; Hepatitis B, Chronic - complications ; Hepatitis B, Chronic - drug therapy ; Humans ; Liver cirrhosis ; Liver Cirrhosis - drug therapy ; Patients ; Tenofovir ; Tenofovir - therapeutic use ; Treatment Outcome</subject><ispartof>Alimentary pharmacology & therapeutics, 2022-01, Vol.55 (1), p.83-96</ispartof><rights>2021 John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons Ltd.</rights><rights>Copyright © 2022 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-564926da9aeabeca5dd0aad6e4724bdf949f2394c5425e65f8864e9fc40d02343</citedby><cites>FETCH-LOGICAL-c3538-564926da9aeabeca5dd0aad6e4724bdf949f2394c5425e65f8864e9fc40d02343</cites><orcidid>0000-0002-7747-4293 ; 0000-0003-3924-0434 ; 0000-0001-6396-0859 ; 0000-0002-6036-2754</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.16658$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.16658$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34662436$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Tae Hyung</creatorcontrib><creatorcontrib>Um, Soon Ho</creatorcontrib><creatorcontrib>Lee, Young‐Sun</creatorcontrib><creatorcontrib>Yim, Sun Young</creatorcontrib><creatorcontrib>Jung, Young Kul</creatorcontrib><creatorcontrib>Seo, Yeon Seok</creatorcontrib><creatorcontrib>Kim, Ji Hoon</creatorcontrib><creatorcontrib>An, Hyunggin</creatorcontrib><creatorcontrib>Yim, Hyung Joon</creatorcontrib><creatorcontrib>Yeon, Jong Eun</creatorcontrib><creatorcontrib>Byun, Kwan Soo</creatorcontrib><title>Determinants of re‐compensation in patients with hepatitis B virus‐related decompensated cirrhosis starting antiviral therapy</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)‐related decompensated cirrhosis.
Aim
To establish a prognostic model to predict re‐compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy
Methods
We analysed 311 consecutive patients with HBV‐related decompensated cirrhosis treated with entecavir or tenofovir. The primary outcome was re‐compensation, defined as recovery to a Child–Pugh score of 5. The BC2AID score was developed from a cohort of 152 subjects based on competing risk models and validated in another cohort of 159 subjects.
Results
Re‐compensation occurred in 57.2% and 66.7% of the subjects in the derivation and validation cohorts, respectively. Six independent predictors for re‐compensation were identified in the derivation cohort and these comprised the BC2AID score: bilirubin ≤5 mg/dL (adjusted sub‐distribution hazard ratio [aSHR] 2.18), absence of severe complications (aSHR 2.78), alpha‐fetoprotein (AFP) ≥50 ng/mL (aSHR 2.54), alanine aminotransferase ≥200 IU/L (aSHR 2.62), international normalised ratio ≤1.5 (aSHR 2.37) and ≤6 months from initial decompensation until initiation of NUCs (aSHR 4.79). In the validation cohort, the area under the receiver operating characteristic curve of the BC2AID score for re‐compensation within 1 year of NUC therapy was significantly higher than that of the Child–Pugh, MELD, MELDNa and BE3A scores (0.813 vs 0.691, 0.638, 0.645 and 0.624, respectively; all P < 0.05).
Conclusions
Six clinical parameters, including AFP and the timing of antiviral therapy, were combined into a scoring system to accurately predict early re‐compensation in patients with HBV‐related decompensated cirrhosis.
The new model consisting of six factors was established to predict re‐compensation of patients with HBV‐related decompensated cirrhosis. It stratified the survival and re‐compensation well.</description><subject>Alanine</subject><subject>Alanine transaminase</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Bilirubin</subject><subject>Cirrhosis</subject><subject>Hepatitis B</subject><subject>Hepatitis B - drug therapy</subject><subject>Hepatitis B virus</subject><subject>Hepatitis B, Chronic - complications</subject><subject>Hepatitis B, Chronic - drug therapy</subject><subject>Humans</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - drug therapy</subject><subject>Patients</subject><subject>Tenofovir</subject><subject>Tenofovir - therapeutic use</subject><subject>Treatment Outcome</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctKBDEQRYMoOj4W_oAE3OiiNe_pXvpWEHSh65DpVDuRfpmkldnpH_iNfokZR10I1qaq4NxbBRehbUoOaKpD08cDqpTMl9CIciUzRrhaRiPCVJGxnPI1tB7CIyFEjQlbRWtcKMUEVyP0dgoRfONa08aAuwp7-Hh9L7umhzaY6LoWuxb3aYI58OLiFE9hvkcX8DF-dn4ISeGhNhEstvCrTVvpvJ92IZEhGh9d-4DTHZdEpsZxCt70s020Upk6wNZ330D352d3J5fZ9c3F1cnRdVZyyfNMKlEwZU1hwEygNNJaYoxVIMZMTGxViKJivBClFEyCklWeKwFFVQpiCeOCb6C9hW_vu6cBQtSNCyXUtWmhG4JmMudC5GPBE7r7B33sBt-m7zRTNKcFHUuVqP0FVfouBA-V7r1rjJ9pSvQ8F51y0V-5JHbn23GYNGB_yZ8gEnC4AF5cDbP_nfTR7d3C8hO4epwh</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Kim, Tae Hyung</creator><creator>Um, Soon Ho</creator><creator>Lee, Young‐Sun</creator><creator>Yim, Sun Young</creator><creator>Jung, Young Kul</creator><creator>Seo, Yeon Seok</creator><creator>Kim, Ji Hoon</creator><creator>An, Hyunggin</creator><creator>Yim, Hyung Joon</creator><creator>Yeon, Jong Eun</creator><creator>Byun, Kwan Soo</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7747-4293</orcidid><orcidid>https://orcid.org/0000-0003-3924-0434</orcidid><orcidid>https://orcid.org/0000-0001-6396-0859</orcidid><orcidid>https://orcid.org/0000-0002-6036-2754</orcidid></search><sort><creationdate>202201</creationdate><title>Determinants of re‐compensation in patients with hepatitis B virus‐related decompensated cirrhosis starting antiviral therapy</title><author>Kim, Tae Hyung ; Um, Soon Ho ; Lee, Young‐Sun ; Yim, Sun Young ; Jung, Young Kul ; Seo, Yeon Seok ; Kim, Ji Hoon ; An, Hyunggin ; Yim, Hyung Joon ; Yeon, Jong Eun ; Byun, Kwan Soo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-564926da9aeabeca5dd0aad6e4724bdf949f2394c5425e65f8864e9fc40d02343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Alanine</topic><topic>Alanine transaminase</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Bilirubin</topic><topic>Cirrhosis</topic><topic>Hepatitis B</topic><topic>Hepatitis B - drug therapy</topic><topic>Hepatitis B virus</topic><topic>Hepatitis B, Chronic - complications</topic><topic>Hepatitis B, Chronic - drug therapy</topic><topic>Humans</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - drug therapy</topic><topic>Patients</topic><topic>Tenofovir</topic><topic>Tenofovir - therapeutic use</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Tae Hyung</creatorcontrib><creatorcontrib>Um, Soon Ho</creatorcontrib><creatorcontrib>Lee, Young‐Sun</creatorcontrib><creatorcontrib>Yim, Sun Young</creatorcontrib><creatorcontrib>Jung, Young Kul</creatorcontrib><creatorcontrib>Seo, Yeon Seok</creatorcontrib><creatorcontrib>Kim, Ji Hoon</creatorcontrib><creatorcontrib>An, Hyunggin</creatorcontrib><creatorcontrib>Yim, Hyung Joon</creatorcontrib><creatorcontrib>Yeon, Jong Eun</creatorcontrib><creatorcontrib>Byun, Kwan Soo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Tae Hyung</au><au>Um, Soon Ho</au><au>Lee, Young‐Sun</au><au>Yim, Sun Young</au><au>Jung, Young Kul</au><au>Seo, Yeon Seok</au><au>Kim, Ji Hoon</au><au>An, Hyunggin</au><au>Yim, Hyung Joon</au><au>Yeon, Jong Eun</au><au>Byun, Kwan Soo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determinants of re‐compensation in patients with hepatitis B virus‐related decompensated cirrhosis starting antiviral therapy</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2022-01</date><risdate>2022</risdate><volume>55</volume><issue>1</issue><spage>83</spage><epage>96</epage><pages>83-96</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)‐related decompensated cirrhosis.
Aim
To establish a prognostic model to predict re‐compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy
Methods
We analysed 311 consecutive patients with HBV‐related decompensated cirrhosis treated with entecavir or tenofovir. The primary outcome was re‐compensation, defined as recovery to a Child–Pugh score of 5. The BC2AID score was developed from a cohort of 152 subjects based on competing risk models and validated in another cohort of 159 subjects.
Results
Re‐compensation occurred in 57.2% and 66.7% of the subjects in the derivation and validation cohorts, respectively. Six independent predictors for re‐compensation were identified in the derivation cohort and these comprised the BC2AID score: bilirubin ≤5 mg/dL (adjusted sub‐distribution hazard ratio [aSHR] 2.18), absence of severe complications (aSHR 2.78), alpha‐fetoprotein (AFP) ≥50 ng/mL (aSHR 2.54), alanine aminotransferase ≥200 IU/L (aSHR 2.62), international normalised ratio ≤1.5 (aSHR 2.37) and ≤6 months from initial decompensation until initiation of NUCs (aSHR 4.79). In the validation cohort, the area under the receiver operating characteristic curve of the BC2AID score for re‐compensation within 1 year of NUC therapy was significantly higher than that of the Child–Pugh, MELD, MELDNa and BE3A scores (0.813 vs 0.691, 0.638, 0.645 and 0.624, respectively; all P < 0.05).
Conclusions
Six clinical parameters, including AFP and the timing of antiviral therapy, were combined into a scoring system to accurately predict early re‐compensation in patients with HBV‐related decompensated cirrhosis.
The new model consisting of six factors was established to predict re‐compensation of patients with HBV‐related decompensated cirrhosis. It stratified the survival and re‐compensation well.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34662436</pmid><doi>10.1111/apt.16658</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-7747-4293</orcidid><orcidid>https://orcid.org/0000-0003-3924-0434</orcidid><orcidid>https://orcid.org/0000-0001-6396-0859</orcidid><orcidid>https://orcid.org/0000-0002-6036-2754</orcidid></addata></record> |
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| subjects | Alanine Alanine transaminase Antiviral agents Antiviral Agents - therapeutic use Bilirubin Cirrhosis Hepatitis B Hepatitis B - drug therapy Hepatitis B virus Hepatitis B, Chronic - complications Hepatitis B, Chronic - drug therapy Humans Liver cirrhosis Liver Cirrhosis - drug therapy Patients Tenofovir Tenofovir - therapeutic use Treatment Outcome |
| title | Determinants of re‐compensation in patients with hepatitis B virus‐related decompensated cirrhosis starting antiviral therapy |
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