{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:15:58Z","timestamp":1792808158837,"version":"4.5.0"},"reference-count":84,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T00:00:00Z","timestamp":1678060800000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2018-02023 (to MG)"],"award-info":[{"award-number":["2018-02023 (to MG)"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003748","name":"Svenska S\u00e4llskapet f\u00f6r Medicinsk Forskning","doi-asserted-by":"publisher","award":["P17-0134 (to LL)"],"award-info":[{"award-number":["P17-0134 (to LL)"]}],"id":[{"id":"10.13039\/501100003748","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003748","name":"Svenska S\u00e4llskapet f\u00f6r Medicinsk Forskning","doi-asserted-by":"publisher","award":["no number (to MG)"],"award-info":[{"award-number":["no number (to MG)"]}],"id":[{"id":"10.13039\/501100003748","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2023,1,17]]},"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) are associated with a wide range of immune-related adverse events. As oncological indications for ICIs widen, their rare side effects become increasingly visible in clinical practice and impact therapy decisions.<\/jats:p>\n                  <jats:p>Here, we report a rare case of early-onset, mild cytokine release syndrome (CRS) in a patient who received ICIs for a metastasized renal cell carcinoma, which led to treatment discontinuation.<\/jats:p>\n                  <jats:p>We further provide a systematic review of the literature of CRS and related life-threatening side effects of ICI treatment, such as hemophagocytic lymphohistiocytosis (HLH). We searched Medline, Embase and the Web of Science Core Collection from inception to October 2021 for reports on CRS, cytokine storm, macrophage activation syndrome, HLH, and related hyperinflammatory disorders in patients with solid cancers receiving ICIs. We found n=1866 articles, which were assessed for eligibility independently by two examiners. Of those, n=49 articles reporting on n=189 individuals were eligible for review. We found that the median time from last infusion to the occurrence of CRS\/HLH was approximately nine days, while the onset of symptoms varied from immediately after infusion to one\u2009month after treatment. Most patients were treated with either corticosteroids or the anti-interleukin 6 (IL-6) antibody tocilizumab, and although the majority of patients recovered, a few cases were fatal. Concomitant IL-6 and ICI treatment were reported as beneficial for both the antitumoral effect and for limiting side effects. Data from international pharmacovigilance databases underscored that ICI-related CRS and HLH are rare events, but we identified significant differences in reported frequencies, which might suggest substantial under-reporting.<\/jats:p>\n                  <jats:p>The results from this first systematic review of CRS\/HLH due to ICI therapy highlight that life-threatening systemic inflammatory complications of ICIs are rare and might be associated with fatal outcome in approximately 10% of patients. Limited data support the use of IL-6 inhibitors in combination with ICIs to augment the antitumoral effect and reduce hyperinflammation.<\/jats:p>","DOI":"10.1136\/jitc-2022-005841","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T06:11:04Z","timestamp":1678947064000},"page":"e005841","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":74,"title":["Systemic inflammatory syndromes as life-threatening side effects of immune checkpoint inhibitors: case report and systematic review of the literature"],"prefix":"10.1136","volume":"11","author":[{"given":"Lisa L","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden"},{"name":"Theme Cancer, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Skribek","sequence":"additional","affiliation":[{"name":"Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden"},{"name":"Theme Cancer, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika","family":"Harmenberg","sequence":"additional","affiliation":[{"name":"Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden"},{"name":"Theme Cancer, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1810-0662","authenticated-orcid":false,"given":"Marco","family":"Gerling","sequence":"additional","affiliation":[{"name":"Theme Cancer, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,6]]},"reference":[{"key":"2025100312502063000_11.3.e005841.1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx225"},{"key":"2025100312502063000_11.3.e005841.2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01440"},{"key":"2025100312502063000_11.3.e005841.3","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2018894618"},{"key":"2025100312502063000_11.3.e005841.4","doi-asserted-by":"publisher","DOI":"10.1136\/ebmed-2017-110885"},{"key":"2025100312502063000_11.3.e005841.5","doi-asserted-by":"crossref","first-page":"2040622320976996","DOI":"10.1177\/2040622320976996","article-title":"Rheumatic immune-related adverse events associated with immune checkpoint inhibitors compared with placebo in oncologic patients: a systemic review and meta-analysis","volume":"12","author":"Zhang","year":"2021","journal-title":"Ther Adv Chronic Dis"},{"key":"2025100312502063000_11.3.e005841.6","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2021-002435","article-title":"Society for immunotherapy of cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events","volume":"9","author":"Brahmer","year":"2021","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.12.756"},{"key":"2025100312502063000_11.3.e005841.8","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-021-00547-6"},{"key":"2025100312502063000_11.3.e005841.9","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0028"},{"key":"2025100312502063000_11.3.e005841.10","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S223468"},{"key":"2025100312502063000_11.3.e005841.11","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1002\/art.38690","article-title":"Development and validation of the hscore, a score for the diagnosis of reactive hemophagocytic syndrome","volume":"66","author":"Fardet","year":"2014","journal-title":"Arthritis Rheumatol"},{"key":"2025100312502063000_11.3.e005841.12","doi-asserted-by":"publisher","DOI":"10.1111\/apa.16013"},{"key":"2025100312502063000_11.3.e005841.13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.34.15_suppl.3061"},{"key":"2025100312502063000_11.3.e005841.14","doi-asserted-by":"publisher","DOI":"10.3163\/1536-5050.104.3.014"},{"key":"2025100312502063000_11.3.e005841.15","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70559-4"},{"key":"2025100312502063000_11.3.e005841.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.12.758"},{"key":"2025100312502063000_11.3.e005841.17","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.807050"},{"key":"2025100312502063000_11.3.e005841.18","doi-asserted-by":"crossref","DOI":"10.1186\/s40425-019-0598-9","article-title":"Haemophagocytic lymphohistiocytosis in patients treated with immune checkpoint inhibitors: analysis of who global database of individual case safety reports","volume":"7","author":"Noseda","year":"2019","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.19","doi-asserted-by":"crossref","first-page":"557","DOI":"10.3389\/fphar.2020.00557","article-title":"Immune checkpoint inhibitor-related cytokine release syndrome: analysis of WHO global pharmacovigilance database","volume":"11","author":"Ceschi","year":"2020","journal-title":"Front Pharmacol"},{"key":"2025100312502063000_11.3.e005841.20","doi-asserted-by":"crossref","DOI":"10.1182\/blood-2019-127586","article-title":"Cytokine release syndrome as a rare complication of nivolumab: a case report","volume":"134","author":"Slota","year":"2019","journal-title":"Blood"},{"key":"2025100312502063000_11.3.e005841.21","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21039"},{"key":"2025100312502063000_11.3.e005841.22","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-01-0172"},{"key":"2025100312502063000_11.3.e005841.23","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1146\/annurev-pathol-042020-042741","article-title":"Immune checkpoint inhibitors for the treatment of cancer: clinical impact and mechanisms of response and resistance","volume":"16","author":"Bagchi","year":"2021","journal-title":"Annu Rev Pathol"},{"key":"2025100312502063000_11.3.e005841.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-13281-y","article-title":"The spatiotemporal dynamics of lung cancer: 30-year trends of epidemiology across 204 countries and territories","volume":"22","author":"Chen","year":"2022","journal-title":"BMC Public Health"},{"key":"2025100312502063000_11.3.e005841.25","unstructured":"Nature Reviews Immunology . Sex differences in immune responses. Available: https:\/\/www.nature.com\/articles\/nri.2016.90 [Accessed 28 Jun 2022]."},{"key":"2025100312502063000_11.3.e005841.26","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jaci.2018.02.018","article-title":"Hypersensitivity reactions to therapeutic monoclonal antibodies: phenotypes and endotypes","volume":"142","author":"Isabwe","year":"2018","journal-title":"J Allergy Clin Immunol"},{"key":"2025100312502063000_11.3.e005841.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2022.04.004"},{"key":"2025100312502063000_11.3.e005841.28","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-311585"},{"key":"2025100312502063000_11.3.e005841.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbrc.2017.02.128"},{"key":"2025100312502063000_11.3.e005841.30","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707447"},{"key":"2025100312502063000_11.3.e005841.31","doi-asserted-by":"publisher","DOI":"10.2217\/imt-2016-0134"},{"key":"2025100312502063000_11.3.e005841.32","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.1016\/j.jtho.2018.11.025","article-title":"Cytokine release syndrome with pseudoprogression in a patient with advanced non-small cell lung cancer treated with pembrolizumab","volume":"14","author":"Kogure","year":"2019","journal-title":"J Thorac Oncol"},{"key":"2025100312502063000_11.3.e005841.33","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16630"},{"key":"2025100312502063000_11.3.e005841.34","doi-asserted-by":"publisher","DOI":"10.1186\/s41199-020-0050-3"},{"key":"2025100312502063000_11.3.e005841.35","article-title":"Heterogeneous outcomes of immune checkpoint inhibitor rechallenge in patients with NSCLC: a systematic review and meta-analysis","volume":"3","author":"Xu","year":"2022","journal-title":"JTO Clin Res Rep"},{"key":"2025100312502063000_11.3.e005841.36","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2020-000621","article-title":"Tocilizumab, but not dexamethasone, prevents CRS without affecting antitumor activity of bispecific antibodies","volume":"8","author":"Kauer","year":"2020","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.37","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.3008226","article-title":"Efficacy and toxicity management of 19-28z CAR T cell therapy in B cell acute lymphoblastic leukemia","volume":"6","author":"Davila","year":"2014","journal-title":"Sci Transl Med"},{"key":"2025100312502063000_11.3.e005841.38","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15644"},{"key":"2025100312502063000_11.3.e005841.39","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-04296-3","article-title":"The differential effects of tumor burdens on predicting the net benefits of sscart-19 cell treatment on r\/r B-ALL patients","volume":"12","author":"Li","year":"2022","journal-title":"Sci Rep"},{"key":"2025100312502063000_11.3.e005841.40","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx701"},{"key":"2025100312502063000_11.3.e005841.41","doi-asserted-by":"crossref","DOI":"10.1186\/s40425-019-0805-8","article-title":"Immune-related adverse events and anti-tumor efficacy of immune checkpoint inhibitors","volume":"7","author":"Das","year":"2019","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2020.102134"},{"key":"2025100312502063000_11.3.e005841.43","doi-asserted-by":"crossref","DOI":"10.3390\/cancers13050989","article-title":"Immune-related adverse events (irAE) in cancer immune checkpoint inhibitors (ICI) and survival outcomes correlation: to rechallenge or not?","volume":"13","author":"Albandar","year":"2021","journal-title":"Cancers (Basel)"},{"key":"2025100312502063000_11.3.e005841.44","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2020-001622","article-title":"Safety of immune checkpoint inhibitor rechallenge after discontinuation for grade \u22652 immune-related adverse events in patients with cancer","volume":"8","author":"Allouchery","year":"2020","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.45","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1001\/jamaoncol.2020.0726","article-title":"Immune checkpoint inhibitor rechallenge after immune-related adverse events in patients with cancer","volume":"6","author":"Dolladille","year":"2020","journal-title":"JAMA Oncol"},{"key":"2025100312502063000_11.3.e005841.46","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx113"},{"key":"2025100312502063000_11.3.e005841.47","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/pbc.26642","article-title":"Severe cytokine release syndrome in a patient receiving PD-1-directed therapy","volume":"64","author":"Rotz","year":"2017","journal-title":"Pediatr Blood Cancer"},{"key":"2025100312502063000_11.3.e005841.48","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx187"},{"key":"2025100312502063000_11.3.e005841.49","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1093\/annonc\/mdw537","article-title":"Coincidence of immunotherapy-associated hemophagocytic syndrome and rapid tumor regression","volume":"28","author":"Takeshita","year":"2017","journal-title":"Ann Oncol"},{"key":"2025100312502063000_11.3.e005841.50","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-018-0365-3"},{"key":"2025100312502063000_11.3.e005841.51","doi-asserted-by":"crossref","DOI":"10.1186\/s40425-018-0384-0","article-title":"Severe hemophagocytic lymphohistiocytosis in a melanoma patient treated with ipilimumab + nivolumab","volume":"6","author":"Hantel","year":"2018","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.52","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.ejca.2018.01.063","article-title":"Treatment-related hemophagocytic lymphohistiocytosissecondary to checkpoint inhibition with nivolumab plus ipilimumab","volume":"93","author":"Satzger","year":"2018","journal-title":"Eur J Cancer"},{"key":"2025100312502063000_11.3.e005841.53","first-page":"S71","article-title":"168 A case of epstein-barr virus-related hemophagocytic lymphohistiocytosis in association with pembrolizumab therapy - proquest","volume":"149","author":"Shah","year":"2018","journal-title":"AJCP"},{"key":"2025100312502063000_11.3.e005841.54","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdy175"},{"key":"2025100312502063000_11.3.e005841.55","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2018.11.035"},{"key":"2025100312502063000_11.3.e005841.56","doi-asserted-by":"publisher","DOI":"10.1159\/000496933"},{"key":"2025100312502063000_11.3.e005841.57","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key447"},{"key":"2025100312502063000_11.3.e005841.58","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.1001-18"},{"key":"2025100312502063000_11.3.e005841.59","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2019.04.026"},{"key":"2025100312502063000_11.3.e005841.60","doi-asserted-by":"crossref","DOI":"10.1186\/s40425-019-0582-4","article-title":"Severe cytokine release syndrome resulting in purpura fulminans despite successful response to nivolumab therapy in a patient with pleomorphic carcinoma of the lung: a case report","volume":"7","author":"Honjo","year":"2019","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.61","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.19.00160"},{"key":"2025100312502063000_11.3.e005841.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmcr.2020.101097"},{"key":"2025100312502063000_11.3.e005841.63","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000019741","article-title":"A case report of fulminant cytokine release syndrome complicated by dermatomyositis after the combination therapy with immune checkpoint inhibitors","volume":"99","author":"Ohira","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"2025100312502063000_11.3.e005841.64","doi-asserted-by":"publisher","DOI":"10.1177\/1078155220980813"},{"key":"2025100312502063000_11.3.e005841.65","doi-asserted-by":"crossref","unstructured":"Gao C , Xu J , Han C , et al . An esophageal cancer case of cytokine release syndrome with multiple-organ injury induced by an anti-PD-1 drug: a case report. Ann Palliat Med 2020;9. doi:10.21037\/apm-20-1310","DOI":"10.21037\/apm-20-1310"},{"key":"2025100312502063000_11.3.e005841.66","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.08.2101"},{"key":"2025100312502063000_11.3.e005841.67","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa750"},{"key":"2025100312502063000_11.3.e005841.68","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.3889-19"},{"key":"2025100312502063000_11.3.e005841.69","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1159\/000507281","article-title":"Hemophagocytic lymphohistiocytosis secondary to PD-1 and IDO inhibition in a patient with refractory glioblastoma","volume":"13","author":"Thummalapalli","year":"2020","journal-title":"Case Rep Oncol"},{"key":"2025100312502063000_11.3.e005841.70","doi-asserted-by":"crossref","DOI":"10.1111\/dth.13321","article-title":"Hemophagocytic lymphohistiocytosis with advanced malignant melanoma accompanied by ipilimumab and nivolumab: a case report and literature review","volume":"33","author":"Mizuta","year":"2020","journal-title":"Dermatol Ther"},{"key":"2025100312502063000_11.3.e005841.71","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.13217"},{"key":"2025100312502063000_11.3.e005841.72","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1053\/j.ajkd.2020.02.267","article-title":"265 ATEZOLIZUMAB associated with tumor lysis syndrome, cytokine release syndrome, and autoimmune toxicity","volume":"75","author":"Nieves-Borrero","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2025100312502063000_11.3.e005841.73","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0000000000000703"},{"key":"2025100312502063000_11.3.e005841.74","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2020-0194"},{"key":"2025100312502063000_11.3.e005841.75","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.5922-20"},{"key":"2025100312502063000_11.3.e005841.76","doi-asserted-by":"publisher","DOI":"10.2217\/imt-2020-0332"},{"key":"2025100312502063000_11.3.e005841.77","doi-asserted-by":"crossref","first-page":"2616","DOI":"10.1111\/ajt.16589","article-title":"Cytokine storm induced by a PD1 inhibitor in a renal transplant patient","volume":"21","author":"Del Bello","year":"2021","journal-title":"Am J Transplant"},{"key":"2025100312502063000_11.3.e005841.78","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2021-002855","article-title":"Pembrolizumab-induced cytokine release syndrome in a patient with metastatic lung adenocarcinoma: a case report","volume":"9","author":"Sackstein","year":"2021","journal-title":"J Immunother Cancer"},{"key":"2025100312502063000_11.3.e005841.79","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/6631859"},{"key":"2025100312502063000_11.3.e005841.80","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.13954"},{"key":"2025100312502063000_11.3.e005841.81","doi-asserted-by":"crossref","DOI":"10.1002\/ccr3.5184","article-title":"Secondary hemophagocytic lymphohistiocytosis due to nivolumab\/ipilimumab in a renal cell cancer patient\u2014a case report","volume":"9","author":"Masood","year":"2021","journal-title":"Clinical Case Reports"},{"key":"2025100312502063000_11.3.e005841.82","doi-asserted-by":"publisher","DOI":"10.14712\/23362936.2022.4"},{"key":"2025100312502063000_11.3.e005841.83","doi-asserted-by":"publisher","DOI":"10.36401\/JIPO-21-9"},{"key":"2025100312502063000_11.3.e005841.84","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.14390"}],"container-title":["Journal for ImmunoTherapy of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jitc-2022-005841","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T19:50:31Z","timestamp":1759521031000},"score":1,"resource":{"primary":{"URL":"https:\/\/jitc.bmj.com\/lookup\/doi\/10.1136\/jitc-2022-005841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":84,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,6]]},"published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1136\/jitc-2022-005841"],"URL":"https:\/\/doi.org\/10.1136\/jitc-2022-005841","relation":{},"ISSN":["2051-1426"],"issn-type":[{"value":"2051-1426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3]]}}}