Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study

Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidi...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of clinical medicine 2022-07, Vol.11 (13), p.3881
Hauptverfasser: Lin, Jiun-Yu, Kao, Pei-Chi, Tsai, Yi-Ting, Chung, Chi-Hsiang, Chien, Wu-Chien, Lin, Chih-Yuan, Lu, Chieh-Hua, Tsai, Chien-Sung
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page
container_issue 13
container_start_page 3881
container_title Journal of clinical medicine
container_volume 11
creator Lin, Jiun-Yu
Kao, Pei-Chi
Tsai, Yi-Ting
Chung, Chi-Hsiang
Chien, Wu-Chien
Lin, Chih-Yuan
Lu, Chieh-Hua
Tsai, Chien-Sung
description Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p < 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p < 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.
doi_str_mv 10.3390/jcm11133881
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9267490</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2686027946</sourcerecordid><originalsourceid>FETCH-LOGICAL-c367t-292fe07d53ec9f859fee5a393734f4d12c5ce86d32db1ed2e7808566097d44f53</originalsourceid><addsrcrecordid>eNpdkk1v1DAQhiMEolXpiTuyxAUJAv5IYocD0nZbupVWgCggcbLceLLrVWIH22mVf8jPwmlLteCLZ_w-emfGmix7TvBbxmr8btf0hBDGhCCPskOKOc8xE-zxXnyQHYeww-kIUVDCn2YHrBSYk0ocZr9X0-DidvLOaBN6dBHQ0nkPnYqg0Y2JW_QDbDQpdz5J_dCZRkXjbEDKarR2dgMerVwYTFQdOlVTEtoIM-ydVX5CC5_SCZ1MgwoBnfskG7tBl6PfzO_GIoW-zhXNNXQT-unGpH5xw9jdFnqPFujTbXRjNLzZU_ITFVKXl3HU07PsSau6AMf391H2_ePZt-UqX38-v1gu1nnDKh5zWtMWMNclg6ZuRVm3AKViNeOsaAtNaFM2ICrNqL4ioClwgUVZVbjmuijakh1lH-58h_GqB92kz_Gqk4M3fZpVOmXkv4o1W7lx17KmFS9qnAxe3Rt492uEEGVvQgNdpyy4MUhaCc5pWTKa0Jf_oTs3epvGm6kKU14XVaJe31GNdyF4aB-aIVjOSyL3liTRL_b7f2D_rgT7A2nyvKY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2686027946</pqid></control><display><type>article</type><title>Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study</title><source>MDPI - Multidisciplinary Digital Publishing Institute</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>PubMed Central Open Access</source><creator>Lin, Jiun-Yu ; Kao, Pei-Chi ; Tsai, Yi-Ting ; Chung, Chi-Hsiang ; Chien, Wu-Chien ; Lin, Chih-Yuan ; Lu, Chieh-Hua ; Tsai, Chien-Sung</creator><creatorcontrib>Lin, Jiun-Yu ; Kao, Pei-Chi ; Tsai, Yi-Ting ; Chung, Chi-Hsiang ; Chien, Wu-Chien ; Lin, Chih-Yuan ; Lu, Chieh-Hua ; Tsai, Chien-Sung</creatorcontrib><description>Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p &lt; 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p &lt; 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm11133881</identifier><identifier>PMID: 35807168</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Age ; Cardiac arrhythmia ; Cardiovascular disease ; Chronic obstructive pulmonary disease ; Clinical medicine ; Comorbidity ; Coronary vessels ; Health insurance ; Heart surgery ; Hospitalization ; Hypothyroidism ; Laboratories ; Mortality ; Ostomy ; Patients ; Pneumonia ; Population ; Population-based studies ; Regression analysis ; Review boards ; Statistical analysis ; Thyroid gland ; Tracheotomy ; Urbanization ; Ventilators</subject><ispartof>Journal of clinical medicine, 2022-07, Vol.11 (13), p.3881</ispartof><rights>2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 by the authors. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c367t-292fe07d53ec9f859fee5a393734f4d12c5ce86d32db1ed2e7808566097d44f53</cites><orcidid>0000-0002-4576-9900 ; 0000-0002-2179-9486 ; 0000-0002-3286-0780</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267490/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267490/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35807168$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lin, Jiun-Yu</creatorcontrib><creatorcontrib>Kao, Pei-Chi</creatorcontrib><creatorcontrib>Tsai, Yi-Ting</creatorcontrib><creatorcontrib>Chung, Chi-Hsiang</creatorcontrib><creatorcontrib>Chien, Wu-Chien</creatorcontrib><creatorcontrib>Lin, Chih-Yuan</creatorcontrib><creatorcontrib>Lu, Chieh-Hua</creatorcontrib><creatorcontrib>Tsai, Chien-Sung</creatorcontrib><title>Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study</title><title>Journal of clinical medicine</title><addtitle>J Clin Med</addtitle><description>Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p &lt; 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p &lt; 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.</description><subject>Age</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical medicine</subject><subject>Comorbidity</subject><subject>Coronary vessels</subject><subject>Health insurance</subject><subject>Heart surgery</subject><subject>Hospitalization</subject><subject>Hypothyroidism</subject><subject>Laboratories</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Population</subject><subject>Population-based studies</subject><subject>Regression analysis</subject><subject>Review boards</subject><subject>Statistical analysis</subject><subject>Thyroid gland</subject><subject>Tracheotomy</subject><subject>Urbanization</subject><subject>Ventilators</subject><issn>2077-0383</issn><issn>2077-0383</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNpdkk1v1DAQhiMEolXpiTuyxAUJAv5IYocD0nZbupVWgCggcbLceLLrVWIH22mVf8jPwmlLteCLZ_w-emfGmix7TvBbxmr8btf0hBDGhCCPskOKOc8xE-zxXnyQHYeww-kIUVDCn2YHrBSYk0ocZr9X0-DidvLOaBN6dBHQ0nkPnYqg0Y2JW_QDbDQpdz5J_dCZRkXjbEDKarR2dgMerVwYTFQdOlVTEtoIM-ydVX5CC5_SCZ1MgwoBnfskG7tBl6PfzO_GIoW-zhXNNXQT-unGpH5xw9jdFnqPFujTbXRjNLzZU_ITFVKXl3HU07PsSau6AMf391H2_ePZt-UqX38-v1gu1nnDKh5zWtMWMNclg6ZuRVm3AKViNeOsaAtNaFM2ICrNqL4ioClwgUVZVbjmuijakh1lH-58h_GqB92kz_Gqk4M3fZpVOmXkv4o1W7lx17KmFS9qnAxe3Rt492uEEGVvQgNdpyy4MUhaCc5pWTKa0Jf_oTs3epvGm6kKU14XVaJe31GNdyF4aB-aIVjOSyL3liTRL_b7f2D_rgT7A2nyvKY</recordid><startdate>20220704</startdate><enddate>20220704</enddate><creator>Lin, Jiun-Yu</creator><creator>Kao, Pei-Chi</creator><creator>Tsai, Yi-Ting</creator><creator>Chung, Chi-Hsiang</creator><creator>Chien, Wu-Chien</creator><creator>Lin, Chih-Yuan</creator><creator>Lu, Chieh-Hua</creator><creator>Tsai, Chien-Sung</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4576-9900</orcidid><orcidid>https://orcid.org/0000-0002-2179-9486</orcidid><orcidid>https://orcid.org/0000-0002-3286-0780</orcidid></search><sort><creationdate>20220704</creationdate><title>Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study</title><author>Lin, Jiun-Yu ; Kao, Pei-Chi ; Tsai, Yi-Ting ; Chung, Chi-Hsiang ; Chien, Wu-Chien ; Lin, Chih-Yuan ; Lu, Chieh-Hua ; Tsai, Chien-Sung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c367t-292fe07d53ec9f859fee5a393734f4d12c5ce86d32db1ed2e7808566097d44f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Clinical medicine</topic><topic>Comorbidity</topic><topic>Coronary vessels</topic><topic>Health insurance</topic><topic>Heart surgery</topic><topic>Hospitalization</topic><topic>Hypothyroidism</topic><topic>Laboratories</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>Population</topic><topic>Population-based studies</topic><topic>Regression analysis</topic><topic>Review boards</topic><topic>Statistical analysis</topic><topic>Thyroid gland</topic><topic>Tracheotomy</topic><topic>Urbanization</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lin, Jiun-Yu</creatorcontrib><creatorcontrib>Kao, Pei-Chi</creatorcontrib><creatorcontrib>Tsai, Yi-Ting</creatorcontrib><creatorcontrib>Chung, Chi-Hsiang</creatorcontrib><creatorcontrib>Chien, Wu-Chien</creatorcontrib><creatorcontrib>Lin, Chih-Yuan</creatorcontrib><creatorcontrib>Lu, Chieh-Hua</creatorcontrib><creatorcontrib>Tsai, Chien-Sung</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lin, Jiun-Yu</au><au>Kao, Pei-Chi</au><au>Tsai, Yi-Ting</au><au>Chung, Chi-Hsiang</au><au>Chien, Wu-Chien</au><au>Lin, Chih-Yuan</au><au>Lu, Chieh-Hua</au><au>Tsai, Chien-Sung</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study</atitle><jtitle>Journal of clinical medicine</jtitle><addtitle>J Clin Med</addtitle><date>2022-07-04</date><risdate>2022</risdate><volume>11</volume><issue>13</issue><spage>3881</spage><pages>3881-</pages><issn>2077-0383</issn><eissn>2077-0383</eissn><abstract>Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p &lt; 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p &lt; 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>35807168</pmid><doi>10.3390/jcm11133881</doi><orcidid>https://orcid.org/0000-0002-4576-9900</orcidid><orcidid>https://orcid.org/0000-0002-2179-9486</orcidid><orcidid>https://orcid.org/0000-0002-3286-0780</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2077-0383
ispartof Journal of clinical medicine, 2022-07, Vol.11 (13), p.3881
issn 2077-0383
2077-0383
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9267490
source MDPI - Multidisciplinary Digital Publishing Institute; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access
subjects Age
Cardiac arrhythmia
Cardiovascular disease
Chronic obstructive pulmonary disease
Clinical medicine
Comorbidity
Coronary vessels
Health insurance
Heart surgery
Hospitalization
Hypothyroidism
Laboratories
Mortality
Ostomy
Patients
Pneumonia
Population
Population-based studies
Regression analysis
Review boards
Statistical analysis
Thyroid gland
Tracheotomy
Urbanization
Ventilators
title Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T17%3A39%3A12IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Hypothyroidism%20Is%20Correlated%20with%20Ventilator%20Complications%20and%20Longer%20Hospital%20Days%20after%20Coronary%20Artery%20Bypass%20Grafting%20Surgery%20in%20a%20Relatively%20Young%20Population:%20A%20Nationwide,%20Population-Based%20Study&rft.jtitle=Journal%20of%20clinical%20medicine&rft.au=Lin,%20Jiun-Yu&rft.date=2022-07-04&rft.volume=11&rft.issue=13&rft.spage=3881&rft.pages=3881-&rft.issn=2077-0383&rft.eissn=2077-0383&rft_id=info:doi/10.3390/jcm11133881&rft_dat=%3Cproquest_pubme%3E2686027946%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2686027946&rft_id=info:pmid/35807168&rfr_iscdi=true