{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T19:21:48Z","timestamp":1778527308131,"version":"3.51.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"15-16","license":[{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Gilead Sciences Austria","award":["IN-AT-540-6258"],"award-info":[{"award-number":["IN-AT-540-6258"]}]},{"name":"Sigmund Freud Privatuniversit\u00e4t Wien"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Klin Wochenschr"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Antiviral drugs have become crucial in managing COVID-19, reducing complications and mortality. Remdesivir has emerged as an effective therapeutic drug for hospitalized patients at risk of disease progression, especially when alternative treatments are infeasible. While the recommended treatment duration of remdesivir extends up to 7\u00a0days post-symptom onset, this study examines how early remdesivir administration impacts clinical outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a\u00a0retrospective analysis using clinical data from consecutively PCR confirmed SARS-CoV\u20112 adult patients (\u2265\u202f18\u00a0years) who received remdesivir during their hospitalization at the department of infectious diseases, Klinik Favoriten in Vienna. The data covered the period from July\u00a01, 2021, to April\u00a031, 2022. Patients were divided into two groups based on the timing of remdesivir administration: an early group (0\u20133\u00a0days since symptom onset) and a\u00a0late group (\u2265\u202f4\u00a0days since symptom onset). The primary outcome was in-hospital disease progression, assessed using the WHO COVID-19 Clinical Progression Scale (\u2265\u202f1\u00a0point increase). Multivariable logistic regression, adjusted for age, sex, SARS-CoV\u20112 variant, and COVID-19 vaccination status, was used to assess clinical outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In total 219 patients were included of whom 148 (67.6%) were in the early group and 71\u00a0(32.4%) were in the late group. The average age was 66.5 (SD: 18.0) years, 68.9% of the patients were vaccinated, and 72.6% had the Omicron virus variant. Late remdesivir administration was associated with a\u00a0significantly higher probability of needing high-flow oxygen therapy (OR 2.52, 95% CI 1.40\u20134.52, <jats:italic>p<\/jats:italic>\u202f=\u20090.002) and ICU admission (OR 4.34, 95% CI 1.38\u201313.67, <jats:italic>p<\/jats:italic>\u202f=\u20090.012) after adjusting for confounders. In the late group there was a\u00a0trend towards a\u00a0higher risk of clinical worsening (OR 2.13, 95% CI 0.98\u20134.64, <jats:italic>p<\/jats:italic>\u202f=\u20090.056) and need for any oxygen therapy (OR 1.85, 95% CI 0.94\u20133.64, <jats:italic>p<\/jats:italic>\u202f=\u20090.074).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Compared to patients who received remdesivir within the first 3\u00a0days after symptom onset, administering remdesivir after day\u00a03 in hospitalized COVID-19 patients is associated with higher risk for complications, such as the need for high-flow oxygen therapy and ICU admission.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00508-024-02377-7","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T15:02:33Z","timestamp":1718636553000},"page":"458-464","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The effect of early remdesivir administration in COVID-19 disease progression in hospitalised patients"],"prefix":"10.1007","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9855-1614","authenticated-orcid":false,"given":"Moritz","family":"Platzer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Totschnig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Karolyi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamara","family":"Clodi-Seitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Wenisch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Zoufaly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,17]]},"reference":[{"key":"2377_CR1","unstructured":"World Health Organization. WHO director-general\u2019s opening remarks at the media briefing on COVID-19. 2020. https:\/\/www.who.int\/director-general\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Accessed 3 July 2023."},{"key":"2377_CR2","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s15010-020-01509-1","volume":"49","author":"D Wolff","year":"2021","unstructured":"Wolff\u00a0D, Nee\u00a0S, Hickey\u00a0NS, Marschollek\u00a0M. Risk factors for Covid-19 severity and fatality: a\u00a0structured literature review. Infection. 2021;49:15\u201328. https:\/\/doi.org\/10.1007\/s15010-020-01509-1.","journal-title":"Infection"},{"key":"2377_CR3","doi-asserted-by":"publisher","first-page":"eaal3653","DOI":"10.1126\/scitranslmed.aal3653","volume":"9","author":"TP Sheahan","year":"2017","unstructured":"Sheahan\u00a0TP, Sims\u00a0AC, Graham\u00a0RL, Menachery\u00a0VD, Gralinski\u00a0LE, Case\u00a0JB, Leist\u00a0SR, Pyrc\u00a0K, Feng\u00a0JY, Trantcheva\u00a0I, et\u00a0al. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Sci Transl Med. 2017;9:eaal3653. https:\/\/doi.org\/10.1126\/scitranslmed.aal3653.","journal-title":"Sci Transl Med"},{"key":"2377_CR4","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1056\/NEJMc2209952","volume":"387","author":"E Takashita","year":"2022","unstructured":"Takashita\u00a0E, Yamayoshi\u00a0S, Fukushi\u00a0S, Suzuki\u00a0T, Maeda\u00a0K, Sakai-Tagawa\u00a0Y, Ito\u00a0M, Uraki\u00a0R, Halfmann\u00a0P, Watanabe\u00a0S, et\u00a0al. Efficacy of antiviral agents against the omicron subvariant BA.2.75. N\u00a0Engl J Med. 2022;387:1236\u20138. https:\/\/doi.org\/10.1056\/NEJMc2209952.","journal-title":"N Engl J Med"},{"key":"2377_CR5","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1038\/s41422-020-0282-0","volume":"30","author":"M Wang","year":"2020","unstructured":"Wang\u00a0M, Cao\u00a0R, Zhang\u00a0L, Yang\u00a0X, Liu\u00a0J, Xu\u00a0M, Shi\u00a0Z, Hu\u00a0Z, Zhong\u00a0W, Xiao\u00a0G. Remdesivir and chloroquine effectively inhibit the recently emerged novel Coronavirus (2019-ncoV) in vitro. Cell Res. 2020;30:269\u201371. https:\/\/doi.org\/10.1038\/s41422-020-0282-0.","journal-title":"Cell Res"},{"key":"2377_CR6","doi-asserted-by":"publisher","first-page":"105252","DOI":"10.1016\/j.antiviral.2022.105252","volume":"198","author":"L Vangeel","year":"2022","unstructured":"Vangeel\u00a0L, Chiu\u00a0W, De Jonghe\u00a0S, Maes\u00a0P, Slechten\u00a0B, Raymenants\u00a0J, Andr\u00e9\u00a0E, Leyssen\u00a0P, Neyts\u00a0J, Jochmans\u00a0D. Remdesivir, molnupiravir and nirmatrelvir remain active against SARS-CoV\u20112 omicron and other variants of concern. Antiviral Res. 2022;198:105252. https:\/\/doi.org\/10.1016\/j.antiviral.2022.105252.","journal-title":"Antiviral Res"},{"key":"2377_CR7","unstructured":"European Medicines Agency. Veklury. https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/veklury. Accessed 3 July 2023."},{"key":"2377_CR8","unstructured":"National Institutes of Health. Remdesivir. https:\/\/www.covid19treatmentguidelines.nih.gov\/therapies\/antivirals-including-antibody-products\/remdesivir\/. Accessed 3 July 2023."},{"key":"2377_CR9","volume-title":"Veklury","author":"European Medicines Agency (EMA)","year":"2020","unstructured":"European Medicines Agency (EMA). Veklury. 2020."},{"key":"2377_CR10","unstructured":"Gilead sciences FDA approves Veklury\u00ae (Remdesivir) for COVID-19 treatment in patients with severe renal impairment, including those on dialysis. https:\/\/www.gilead.com\/news-and-press\/press-room\/press-releases\/2023\/7\/fda-approves-veklury-remdesivir-for-covid19-treatment-in-patients-with-severe-renal-impairment-including-those-on-dialysis. Accessed 3 Oct 2023."},{"key":"2377_CR11","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1016\/S0140-6736(22)00519-0","volume":"399","author":"WHO Solidarity Trial Consortium","year":"2022","unstructured":"WHO Solidarity Trial Consortium. Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO solidarity randomised trial and updated meta-analyses. Lancet. 2022;399:1941\u201353. https:\/\/doi.org\/10.1016\/S0140-6736(22)00519-0.","journal-title":"Lancet"},{"key":"2377_CR12","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1016\/j.cmi.2022.04.018","volume":"28","author":"TC Lee","year":"2022","unstructured":"Lee\u00a0TC, Murthy\u00a0S, Del Corpo\u00a0O, Sen\u00e9cal\u00a0J, Butler-Laporte\u00a0G, Sohani\u00a0ZN, Brophy\u00a0JM, McDonald\u00a0EG. Remdesivir for the treatment of COVID-19: a\u00a0systematic review and meta-analysis. Clin Microbiol Infect. 2022;28:1203\u201310. https:\/\/doi.org\/10.1016\/j.cmi.2022.04.018.","journal-title":"Clin Microbiol Infect"},{"key":"2377_CR13","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/S2213-2600(22)00528-8","volume":"11","author":"A Amstutz","year":"2023","unstructured":"Amstutz\u00a0A, Speich\u00a0B, Mentr\u00e9\u00a0F, Rueegg\u00a0CS, Belhadi\u00a0D, Assoumou\u00a0L, Burdet\u00a0C, Murthy\u00a0S, Dodd\u00a0LE, Wang\u00a0Y, et\u00a0al. Effects of remdesivir in patients hospitalised with COVID-19: a\u00a0systematic review and individual patient data meta-analysis of randomised controlled trials. Lancet Respir Med. 2023;11:453\u201364. https:\/\/doi.org\/10.1016\/S2213-2600(22)00528-8.","journal-title":"Lancet Respir Med"},{"key":"2377_CR14","doi-asserted-by":"publisher","first-page":"CD014962","DOI":"10.1002\/14651858.CD014962.pub2","volume":"1","author":"F Grundeis","year":"2023","unstructured":"Grundeis\u00a0F, Ansems\u00a0K, Dahms\u00a0K, Thieme\u00a0V, Metzendorf\u00a0M\u2011I, Skoetz\u00a0N, Benstoem\u00a0C, Mikolajewska\u00a0A, Griesel\u00a0M, Fichtner\u00a0F, et\u00a0al. Remdesivir for the treatment of COVID-19. Cochrane Database Syst Rev. 2023;1:CD14962. https:\/\/doi.org\/10.1002\/14651858.CD014962.pub2.","journal-title":"Cochrane Database Syst Rev"},{"key":"2377_CR15","doi-asserted-by":"publisher","first-page":"e048416","DOI":"10.1136\/bmjopen-2020-048416","volume":"11","author":"S Singh","year":"2021","unstructured":"Singh\u00a0S, Khera\u00a0D, Chugh\u00a0A, Khera\u00a0PS, Chugh\u00a0VK. Efficacy and safety of remdesivir in COVID-19 caused by SARS-coV-2: a\u00a0systematic review and meta-analysis. BMJ Open. 2021;11:e48416. https:\/\/doi.org\/10.1136\/bmjopen-2020-048416.","journal-title":"BMJ Open"},{"key":"2377_CR16","doi-asserted-by":"publisher","first-page":"E242","DOI":"10.1503\/cmaj.211698","volume":"194","author":"K Ali","year":"2022","unstructured":"Ali\u00a0K, Azher\u00a0T, Baqi\u00a0M, Binnie\u00a0A, Borgia\u00a0S, Carrier\u00a0FM, Cavayas\u00a0YA, Chagnon\u00a0N, Cheng\u00a0MP, Conly\u00a0J, et\u00a0al. Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a\u00a0randomized controlled trial. CMAJ. 2022;194:E242\u2013E51. https:\/\/doi.org\/10.1503\/cmaj.211698.","journal-title":"CMAJ"},{"key":"2377_CR17","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1056\/NEJMoa2007764","volume":"383","author":"JH Beigel","year":"2020","unstructured":"Beigel\u00a0JH, Tomashek\u00a0KM, Dodd\u00a0LE, Mehta\u00a0AK, Zingman\u00a0BS, Kalil\u00a0AC, Hohmann\u00a0E, Chu\u00a0HY, Luetkemeyer\u00a0A, Kline\u00a0S, et\u00a0al. Remdesivir for the treatment of Covid-19\u2014final report. N\u00a0Engl J Med. 2020;383:1813\u201326. https:\/\/doi.org\/10.1056\/NEJMoa2007764.","journal-title":"N Engl J Med"},{"key":"2377_CR18","volume-title":"COVID-19 treatment guideline","author":"National Institutes of Health (NIH)","year":"2023","unstructured":"National Institutes of Health (NIH). COVID-19 treatment guideline. 2023."},{"key":"2377_CR19","unstructured":"Infectious Disease Society America. IDSA guidelines on the treatment and management of patients with COVID-19. https:\/\/www.idsociety.org\/practice-guideline\/covid-19-guideline-treatment-and-management\/. Accessed 29 Oct 2023."},{"key":"2377_CR20","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1086\/341405","volume":"35","author":"F Raschilas","year":"2002","unstructured":"Raschilas\u00a0F, Wolff\u00a0M, Delatour\u00a0F, Chaffaut\u00a0C, De Broucker\u00a0T, Chevret\u00a0S, Lebon\u00a0P, Canton\u00a0P, Rozenberg\u00a0F. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a\u00a0multicenter study. Clin Infect Dis. 2002;35:254\u201360. https:\/\/doi.org\/10.1086\/341405.","journal-title":"Clin Infect Dis"},{"key":"2377_CR21","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1093\/jac\/dkg007","volume":"51","author":"FY Aoki","year":"2003","unstructured":"Aoki\u00a0FY, Macleod\u00a0MD, Paggiaro\u00a0P, Carewicz\u00a0O, El Sawy\u00a0A, Wat\u00a0C, Griffiths\u00a0M, Waalberg\u00a0E, Ward\u00a0P, IMPACT Study Group. Early administration of oral oseltamivir increases the benefits of influenza treatment. J\u00a0Antimicrob Chemother. 2003;51:123\u20139. https:\/\/doi.org\/10.1093\/jac\/dkg007.","journal-title":"J Antimicrob Chemother"},{"key":"2377_CR22","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1056\/NEJMoa2116846","volume":"386","author":"RL Gottlieb","year":"2022","unstructured":"Gottlieb\u00a0RL, Vaca\u00a0CE, Paredes\u00a0R, Mera\u00a0J, Webb\u00a0BJ, Perez\u00a0G, Oguchi\u00a0G, Ryan\u00a0P, Nielsen\u00a0BU, Brown\u00a0M, et\u00a0al. Early remdesivir to prevent progression to severe Covid-19 in outpatients. N\u00a0Engl J Med. 2022;386:305\u201315. https:\/\/doi.org\/10.1056\/NEJMoa2116846.","journal-title":"N Engl J Med"},{"key":"2377_CR23","doi-asserted-by":"publisher","first-page":"e192","DOI":"10.1016\/S1473-3099(20)30483-7","volume":"20","author":"WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection","year":"2020","unstructured":"WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020;20:e192\u2013e7. https:\/\/doi.org\/10.1016\/S1473-3099(20)30483-7.","journal-title":"Lancet Infect Dis"},{"key":"2377_CR24","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1186\/s12879-023-08222-y","volume":"23","author":"R Alonso-Navarro","year":"2023","unstructured":"Alonso-Navarro\u00a0R, Ram\u00edrez\u00a0M, Masi\u00e1\u00a0M, Paredes\u00a0R, Montejano\u00a0R, Povar-Echeverria\u00a0M, Carratal\u00e0\u00a0J, Salavert\u00a0M, Bernal\u00a0E, Due\u00f1as\u00a0C, et\u00a0al. Time from symptoms onset to remdesivir is associated with the risk of ICU admission: a\u00a0multicentric analyses. BMC Infect Dis. 2023;23:286. https:\/\/doi.org\/10.1186\/s12879-023-08222-y.","journal-title":"BMC Infect Dis"},{"key":"2377_CR25","doi-asserted-by":"publisher","first-page":"ofac502","DOI":"10.1093\/ofid\/ofac502","volume":"9","author":"S Rajme-L\u00f3pez","year":"2022","unstructured":"Rajme-L\u00f3pez\u00a0S, Martinez-Guerra\u00a0BA, Zalapa-Soto\u00a0J, Rom\u00e1n-Montes\u00a0CM, Tamez-Torres\u00a0KM, Gonz\u00e1lez-Lara\u00a0MF, Hernandez-Gilosul\u00a0T, Kershenobich-Stalnikowitz\u00a0D, Sifuentes-Osornio\u00a0J, Ponce-de-Le\u00f3n\u00a0A, et\u00a0al. Early outpatient treatment with remdesivir in patients at high risk for severe COVID-19: a\u00a0prospective cohort study. Open Forum Infect Dis. 2022;9:ofac502. https:\/\/doi.org\/10.1093\/ofid\/ofac502.","journal-title":"Open Forum Infect Dis"},{"key":"2377_CR26","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1097\/TP.0000000000004394","volume":"107","author":"KW Dewey","year":"2023","unstructured":"Dewey\u00a0KW, Yen\u00a0B, Lazo\u00a0J, Seijo\u00a0L, Jariwala\u00a0R, Shah\u00a0RJ, Quan\u00a0D, Carpenter\u00a0B, Paul Singer\u00a0J, Breen\u00a0K, et\u00a0al. Nirmatrelvir\/ritonavir use with tacrolimus in lung transplant recipients: a\u00a0single-center case series. Transplantation. 2023;107:1200\u20135. https:\/\/doi.org\/10.1097\/TP.0000000000004394.","journal-title":"Transplantation"},{"key":"2377_CR27","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1056\/NEJMoa2208822","volume":"388","author":"Z Cao","year":"2023","unstructured":"Cao\u00a0Z, Gao\u00a0W, Bao\u00a0H, Feng\u00a0H, Mei\u00a0S, Chen\u00a0P, Gao\u00a0Y, Cui\u00a0Z, Zhang\u00a0Q, Meng\u00a0X, et\u00a0al. VV116 versus nirmatrelvir-ritonavir for oral treatment of Covid-19. N\u00a0Engl J Med. 2023;388:406\u201317. https:\/\/doi.org\/10.1056\/NEJMoa2208822.","journal-title":"N Engl J Med"}],"container-title":["Wiener klinische Wochenschrift"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-024-02377-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00508-024-02377-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-024-02377-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T09:20:42Z","timestamp":1723713642000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00508-024-02377-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,17]]},"references-count":27,"journal-issue":{"issue":"15-16","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["2377"],"URL":"https:\/\/doi.org\/10.1007\/s00508-024-02377-7","relation":{},"ISSN":["0043-5325","1613-7671"],"issn-type":[{"value":"0043-5325","type":"print"},{"value":"1613-7671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,17]]},"assertion":[{"value":"22 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"M.\u00a0Platzer, D.\u00a0Totschnig, M.\u00a0Karolyi, T.\u00a0Clodi-Seitz, C.\u00a0Wenisch and A.\u00a0Zoufaly declare that they have no competing interests. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of City of Vienna (EK 22-219-VK, 28.11.2022). Patient consent was waived due to the retrospective nature of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}