Djillali Annane1, Eric Bellissant2, Pierre Edouard Bollaert3, Josef Briegel4, Didier Keh5, Yizhak Kupfer6, Romain Pirracchio7, Bram Rochwerg8. 1. Center for Neuromuscular Diseases; Raymond Poincaré Hospital (AP-HP), Department of Critical Care, Hyperbaric Medicine and Home Respiratory Unit, Faculty of Health Sciences Simone Veil, University of Versailles SQY- University of Paris Saclay, 104 Boulevard Raymond Poincaré, Garches, France, 92380. 2. Hôpital Pontchaillou, Centre d'Investigation Clinique INSERM 0203, Rennes, France, 35033. 3. Hôpital Central, Intensive Care Unit, Nancy, France, 54000. 4. Klinikum der Universität, Klinik fur Anästhesiologie, München, Germany, 81377. 5. Charité-Campus Virchow Clinic, Charité Universitätsmedizin Berlin, University Clinic of Anesthesiology and Intensive Care Medicine CCM/CVK, Augustenburger Platz 1, Berlin, Germany, 13353. 6. Maimonides Medical Center, Division of Pulmonary and Critical Care Medicine, 4802 Tenth Avenue, Brooklyn, New York, USA, 11219. 7. Zuckerberg San Francisco General Hospital and Trauma Center, University of California, Department of Anesthesia and Perioperative Medicine, San Francisco, California, USA. 8. McMaster University, Division of Critical Care, Department of Medicine, Box 211, Juravinski Hospital, 711 Concession St, Hamilton, Ontario, Canada.
Abstract
BACKGROUND: Sepsis occurs when an infection is complicated by organ failure. Sepsis may be complicated by impaired corticosteroid metabolism. Thus, providing corticosteroids may benefit patients. The original review was published in 2004 and was updated in 2010 and 2015 prior to this update. OBJECTIVES: To examine the effects of corticosteroids on death in children and adults with sepsis. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, ISRCTN, and the WHO Clinical Trials Search Portal, on 25 July 2019. In addition, we conducted reference checking and citation searching, and contacted study authors, to identify additional studies as needed. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of corticosteroids versus placebo or usual care (antimicrobials, fluid replacement, and vasopressor therapy as needed) in children and adults with sepsis. We also included RCTs of continuous infusion versus intermittent bolus of corticosteroids. DATA COLLECTION AND ANALYSIS: All review authors screened and selected studies for inclusion. One review author extracted data, which was checked by the others, and by the lead author of the primary study when possible. We obtained unpublished data from the authors of some trials. We assessed the methodological quality of trials and applied GRADE to assess the certainty of evidence. Review authors did not contribute to assessment of eligibility and risk of bias, nor to data extraction, for trials they had participated in. MAIN RESULTS: We included 61 trials (12,192 participants), of which six included only children, two included children and adults, and the remaining trials included only adults. Nine studies are ongoing and will be considered in future versions of this review. We judged 19 trials as being at low risk of bias. Corticosteroids versus placebo or usual care Compared to placebo or usual care, corticosteroids probably slightly reduce 28-day mortality (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.84 to 0.99; 11,233 participants; 50 studies; moderate-certainty evidence). Corticosteroids may result in little to no difference in long-term mortality (RR 0.97, 95% CI 0.91 to 1.03; 6236 participants; 7 studies; low-certainty evidence) and probably slightly reduce hospital mortality (RR 0.90, 95% CI 0.82 to 0.99; 8183 participants; 26 trials; moderate-certainty evidence). Corticosteroids reduced length of intensive care unit (ICU) stay for all participants (mean difference (MD) -1.07 days, 95% CI -1.95 to -0.19; 7612 participants; 21 studies; high-certainty evidence) and resulted in a large reduction in length of hospital stay for all participants (MD -1.63 days, 95% CI -2.93 to -0.33; 8795 participants; 22 studies; high-certainty evidence). Corticosteroids increase the risk of muscle weakness (RR 1.21, 95% CI 1.01 to 1.44; 6145 participants; 6 studies; high-certainty evidence). Corticosteroids probably do not increase the risk of superinfection (RR 1.06, 95% CI 0.95 to 1.19; 5356 participants; 25 studies; moderate-certainty evidence). Corticosteroids increase the risk of hypernatraemia (high-certainty evidence) and probably increase the risk of hyperglycaemia (moderate-certainty evidence). Moderate-certainty evidence shows that there is probably little or no difference in gastroduodenal bleeding, stroke, or cardiac events, and low-certainty evidence suggests that corticosteroids may result in little to no difference in neuropsychiatric events. Continuous infusion of corticosteroids versus intermittent bolus We are uncertain about the effects of continuous infusion of corticosteroids compared with intermittent bolus administration. Three studies reported data for this comparison, and the certainty of evidence for all outcomes was very low. AUTHORS' CONCLUSIONS: Moderate-certainty evidence indicates that corticosteroids probably reduce 28-day and hospital mortality among patients with sepsis. Corticosteroids result in large reductions in ICU and hospital length of stay (high-certainty evidence). There may be little or no difference in the risk of major complications; however, corticosteroids increase the risk of muscle weakness and hypernatraemia, and probably increase the risk of hyperglycaemia. The effects of continuous versus intermittent bolus administration of corticosteroids are uncertain.
BACKGROUND: Sepsis occurs when an infection is complicated by organ failure. Sepsis may be complicated by impaired corticosteroid metabolism. Thus, providing corticosteroids may benefit patients. The original review was published in 2004 and was updated in 2010 and 2015 prior to this update. OBJECTIVES: To examine the effects of corticosteroids on death in children and adults with sepsis. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, ISRCTN, and the WHO Clinical Trials Search Portal, on 25 July 2019. In addition, we conducted reference checking and citation searching, and contacted study authors, to identify additional studies as needed. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of corticosteroids versus placebo or usual care (antimicrobials, fluid replacement, and vasopressor therapy as needed) in children and adults with sepsis. We also included RCTs of continuous infusion versus intermittent bolus of corticosteroids. DATA COLLECTION AND ANALYSIS: All review authors screened and selected studies for inclusion. One review author extracted data, which was checked by the others, and by the lead author of the primary study when possible. We obtained unpublished data from the authors of some trials. We assessed the methodological quality of trials and applied GRADE to assess the certainty of evidence. Review authors did not contribute to assessment of eligibility and risk of bias, nor to data extraction, for trials they had participated in. MAIN RESULTS: We included 61 trials (12,192 participants), of which six included only children, two included children and adults, and the remaining trials included only adults. Nine studies are ongoing and will be considered in future versions of this review. We judged 19 trials as being at low risk of bias. Corticosteroids versus placebo or usual care Compared to placebo or usual care, corticosteroids probably slightly reduce 28-day mortality (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.84 to 0.99; 11,233 participants; 50 studies; moderate-certainty evidence). Corticosteroids may result in little to no difference in long-term mortality (RR 0.97, 95% CI 0.91 to 1.03; 6236 participants; 7 studies; low-certainty evidence) and probably slightly reduce hospital mortality (RR 0.90, 95% CI 0.82 to 0.99; 8183 participants; 26 trials; moderate-certainty evidence). Corticosteroids reduced length of intensive care unit (ICU) stay for all participants (mean difference (MD) -1.07 days, 95% CI -1.95 to -0.19; 7612 participants; 21 studies; high-certainty evidence) and resulted in a large reduction in length of hospital stay for all participants (MD -1.63 days, 95% CI -2.93 to -0.33; 8795 participants; 22 studies; high-certainty evidence). Corticosteroids increase the risk of muscle weakness (RR 1.21, 95% CI 1.01 to 1.44; 6145 participants; 6 studies; high-certainty evidence). Corticosteroids probably do not increase the risk of superinfection (RR 1.06, 95% CI 0.95 to 1.19; 5356 participants; 25 studies; moderate-certainty evidence). Corticosteroids increase the risk of hypernatraemia (high-certainty evidence) and probably increase the risk of hyperglycaemia (moderate-certainty evidence). Moderate-certainty evidence shows that there is probably little or no difference in gastroduodenal bleeding, stroke, or cardiac events, and low-certainty evidence suggests that corticosteroids may result in little to no difference in neuropsychiatric events. Continuous infusion of corticosteroids versus intermittent bolus We are uncertain about the effects of continuous infusion of corticosteroids compared with intermittent bolus administration. Three studies reported data for this comparison, and the certainty of evidence for all outcomes was very low. AUTHORS' CONCLUSIONS: Moderate-certainty evidence indicates that corticosteroids probably reduce 28-day and hospital mortality among patients with sepsis. Corticosteroids result in large reductions in ICU and hospital length of stay (high-certainty evidence). There may be little or no difference in the risk of major complications; however, corticosteroids increase the risk of muscle weakness and hypernatraemia, and probably increase the risk of hyperglycaemia. The effects of continuous versus intermittent bolus administration of corticosteroids are uncertain.
Authors: Paul E Marik; Stephen M Pastores; Djillali Annane; G Umberto Meduri; Charles L Sprung; Wiebke Arlt; Didier Keh; Josef Briegel; Albertus Beishuizen; Ioanna Dimopoulou; Stylianos Tsagarakis; Mervyn Singer; George P Chrousos; Gary Zaloga; Faran Bokhari; Michael Vogeser Journal: Crit Care Med Date: 2008-06 Impact factor: 7.598
Authors: Bram Peeters; Philippe Meersseman; Sarah Vander Perre; Pieter J Wouters; Yves Debaveye; Lies Langouche; Greet Van den Berghe Journal: Intensive Care Med Date: 2018-10-29 Impact factor: 17.440
Authors: Jonathan A C Sterne; Srinivas Murthy; Janet V Diaz; Arthur S Slutsky; Jesús Villar; Derek C Angus; Djillali Annane; Luciano Cesar Pontes Azevedo; Otavio Berwanger; Alexandre B Cavalcanti; Pierre-Francois Dequin; Bin Du; Jonathan Emberson; David Fisher; Bruno Giraudeau; Anthony C Gordon; Anders Granholm; Cameron Green; Richard Haynes; Nicholas Heming; Julian P T Higgins; Peter Horby; Peter Jüni; Martin J Landray; Amelie Le Gouge; Marie Leclerc; Wei Shen Lim; Flávia R Machado; Colin McArthur; Ferhat Meziani; Morten Hylander Møller; Anders Perner; Marie Warrer Petersen; Jelena Savovic; Bruno Tomazini; Viviane C Veiga; Steve Webb; John C Marshall Journal: JAMA Date: 2020-10-06 Impact factor: 56.272
Authors: Derek C Angus; Lennie Derde; Farah Al-Beidh; Djillali Annane; Yaseen Arabi; Abigail Beane; Wilma van Bentum-Puijk; Lindsay Berry; Zahra Bhimani; Marc Bonten; Charlotte Bradbury; Frank Brunkhorst; Meredith Buxton; Adrian Buzgau; Allen C Cheng; Menno de Jong; Michelle Detry; Lise Estcourt; Mark Fitzgerald; Herman Goossens; Cameron Green; Rashan Haniffa; Alisa M Higgins; Christopher Horvat; Sebastiaan J Hullegie; Peter Kruger; Francois Lamontagne; Patrick R Lawler; Kelsey Linstrum; Edward Litton; Elizabeth Lorenzi; John Marshall; Daniel McAuley; Anna McGlothin; Shay McGuinness; Bryan McVerry; Stephanie Montgomery; Paul Mouncey; Srinivas Murthy; Alistair Nichol; Rachael Parke; Jane Parker; Kathryn Rowan; Ashish Sanil; Marlene Santos; Christina Saunders; Christopher Seymour; Anne Turner; Frank van de Veerdonk; Balasubramanian Venkatesh; Ryan Zarychanski; Scott Berry; Roger J Lewis; Colin McArthur; Steven A Webb; Anthony C Gordon; Farah Al-Beidh; Derek Angus; Djillali Annane; Yaseen Arabi; Wilma van Bentum-Puijk; Scott Berry; Abigail Beane; Zahra Bhimani; Marc Bonten; Charlotte Bradbury; Frank Brunkhorst; Meredith Buxton; Allen Cheng; Menno De Jong; Lennie Derde; Lise Estcourt; Herman Goossens; Anthony Gordon; Cameron Green; Rashan Haniffa; Francois Lamontagne; Patrick Lawler; Edward Litton; John Marshall; Daniel McAuley; Shay McGuinness; Bryan McVerry; Stephanie Montgomery; Paul Mouncey; Srinivas Murthy; Alistair Nichol; Rachael Parke; Kathryn Rowan; Christopher Seymour; Anne Turner; Frank van de Veerdonk; Steve Webb; Ryan Zarychanski; Lewis Campbell; Andrew Forbes; David Gattas; Stephane Heritier; Lisa Higgins; Peter Kruger; Sandra Peake; Jeffrey Presneill; Ian Seppelt; Tony Trapani; Paul Young; Sean Bagshaw; Nick Daneman; Niall Ferguson; Cheryl Misak; Marlene Santos; Sebastiaan Hullegie; Mathias Pletz; Gernot Rohde; Kathy Rowan; Brian Alexander; Kim Basile; Timothy Girard; Christopher Horvat; David Huang; Kelsey Linstrum; Jennifer Vates; Richard Beasley; Robert Fowler; Steve McGloughlin; Susan Morpeth; David Paterson; Bala Venkatesh; Tim Uyeki; Kenneth Baillie; Eamon Duffy; Rob Fowler; Thomas Hills; Katrina Orr; Asad Patanwala; Steve Tong; Mihai Netea; Shilesh Bihari; Marc Carrier; Dean Fergusson; Ewan Goligher; Ghady Haidar; Beverley Hunt; Anand Kumar; Mike Laffan; Patrick Lawless; Sylvain Lother; Peter McCallum; Saskia Middeldopr; Zoe McQuilten; Matthew Neal; John Pasi; Roger Schutgens; Simon Stanworth; Alexis Turgeon; Alexandra Weissman; Neill Adhikari; Matthew Anstey; Emily Brant; Angelique de Man; Francois Lamonagne; Marie-Helene Masse; Andrew Udy; Donald Arnold; Phillipe Begin; Richard Charlewood; Michael Chasse; Mark Coyne; Jamie Cooper; James Daly; Iain Gosbell; Heli Harvala-Simmonds; Tom Hills; Sheila MacLennan; David Menon; John McDyer; Nicole Pridee; David Roberts; Manu Shankar-Hari; Helen Thomas; Alan Tinmouth; Darrell Triulzi; Tim Walsh; Erica Wood; Carolyn Calfee; Cecilia O’Kane; Murali Shyamsundar; Pratik Sinha; Taylor Thompson; Ian Young; Shailesh Bihari; Carol Hodgson; John Laffey; Danny McAuley; Neil Orford; Ary Neto; Michelle Detry; Mark Fitzgerald; Roger Lewis; Anna McGlothlin; Ashish Sanil; Christina Saunders; Lindsay Berry; Elizabeth Lorenzi; Eliza Miller; Vanessa Singh; Claire Zammit; Wilma van Bentum Puijk; Wietske Bouwman; Yara Mangindaan; Lorraine Parker; Svenja Peters; Ilse Rietveld; Kik Raymakers; Radhika Ganpat; Nicole Brillinger; Rene Markgraf; Kate Ainscough; Kathy Brickell; Aisha Anjum; Janis-Best Lane; Alvin Richards-Belle; Michelle Saull; Daisy Wiley; Julian Bion; Jason Connor; Simon Gates; Victoria Manax; Tom van der Poll; John Reynolds; Marloes van Beurden; Evelien Effelaar; Joost Schotsman; Craig Boyd; Cain Harland; Audrey Shearer; Jess Wren; Giles Clermont; William Garrard; Kyle Kalchthaler; Andrew King; Daniel Ricketts; Salim Malakoutis; Oscar Marroquin; Edvin Music; Kevin Quinn; Heidi Cate; Karen Pearson; Joanne Collins; Jane Hanson; Penny Williams; Shane Jackson; Adeeba Asghar; Sarah Dyas; Mihaela Sutu; Sheenagh Murphy; Dawn Williamson; Nhlanhla Mguni; Alison Potter; David Porter; Jayne Goodwin; Clare Rook; Susie Harrison; Hannah Williams; Hilary Campbell; Kaatje Lomme; James Williamson; Jonathan Sheffield; Willian van’t Hoff; Phobe McCracken; Meredith Young; Jasmin Board; Emma Mart; Cameron Knott; Julie Smith; Catherine Boschert; Julia Affleck; Mahesh Ramanan; Ramsy D’Souza; Kelsey Pateman; Arif Shakih; Winston Cheung; Mark Kol; Helen Wong; Asim Shah; Atul Wagh; Joanne Simpson; Graeme Duke; Peter Chan; Brittney Cartner; Stephanie Hunter; Russell Laver; Tapaswi Shrestha; Adrian Regli; Annamaria Pellicano; James McCullough; Mandy Tallott; Nikhil Kumar; Rakshit Panwar; Gail Brinkerhoff; Cassandra Koppen; Federica Cazzola; Matthew Brain; Sarah Mineall; Roy Fischer; Vishwanath Biradar; Natalie Soar; Hayden White; Kristen Estensen; Lynette Morrison; Joanne Smith; Melanie Cooper; Monash Health; Yahya Shehabi; Wisam Al-Bassam; Amanda Hulley; Christina Whitehead; Julie Lowrey; Rebecca Gresha; James Walsham; Jason Meyer; Meg Harward; Ellen Venz; Patricia Williams; Catherine Kurenda; Kirsy Smith; Margaret Smith; Rebecca Garcia; Deborah Barge; Deborah Byrne; Kathleen Byrne; Alana Driscoll; Louise Fortune; Pierre Janin; Elizabeth Yarad; Naomi Hammond; Frances Bass; Angela Ashelford; Sharon Waterson; Steve Wedd; Robert McNamara; Heidi Buhr; Jennifer Coles; Sacha Schweikert; Bradley Wibrow; Rashmi Rauniyar; Erina Myers; Ed Fysh; Ashlish Dawda; Bhaumik Mevavala; Ed Litton; Janet Ferrier; Priya Nair; Hergen Buscher; Claire Reynolds; John Santamaria; Leanne Barbazza; Jennifer Homes; Roger Smith; Lauren Murray; Jane Brailsford; Loretta Forbes; Teena Maguire; Vasanth Mariappa; Judith Smith; Scott Simpson; Matthew Maiden; Allsion Bone; Michelle Horton; Tania Salerno; Martin Sterba; Wenli Geng; Pieter Depuydt; Jan De Waele; Liesbet De Bus; Jan Fierens; Stephanie Bracke; Brenda Reeve; William Dechert; Michaël Chassé; François Martin Carrier; Dounia Boumahni; Fatna Benettaib; Ali Ghamraoui; David Bellemare; Ève Cloutier; Charles Francoeur; François Lamontagne; Frédérick D’Aragon; Elaine Carbonneau; Julie Leblond; Gloria Vazquez-Grande; Nicole Marten; Martin Albert; Karim Serri; Alexandros Cavayas; Mathilde Duplaix; Virginie Williams; Bram Rochwerg; Tim Karachi; Simon Oczkowski; John Centofanti; Tina Millen; Erick Duan; Jennifer Tsang; Lisa Patterson; Shane English; Irene Watpool; Rebecca Porteous; Sydney Miezitis; Lauralyn McIntyre; Laurent Brochard; Karen Burns; Gyan Sandhu; Imrana Khalid; Alexandra Binnie; Elizabeth Powell; Alexandra McMillan; Tracy Luk; Noah Aref; Zdravko Andric; Sabina Cviljevic; Renata Đimoti; Marija Zapalac; Gordan Mirković; Bruno Baršić; Marko Kutleša; Viktor Kotarski; Ana Vujaklija Brajković; Jakša Babel; Helena Sever; Lidija Dragija; Ira Kušan; Suvi Vaara; Leena Pettilä; Jonna Heinonen; Anne Kuitunen; Sari Karlsson; Annukka Vahtera; Heikki Kiiski; Sanna Ristimäki; Amine Azaiz; Cyril Charron; Mathieu Godement; Guillaume Geri; Antoine Vieillard-Baron; Franck Pourcine; Mehran Monchi; David Luis; Romain Mercier; Anne Sagnier; Nathalie Verrier; Cecile Caplin; Shidasp Siami; Christelle Aparicio; Sarah Vautier; Asma Jeblaoui; Muriel Fartoukh; Laura Courtin; Vincent Labbe; Cécile Leparco; Grégoire Muller; Mai-Anh Nay; Toufik Kamel; Dalila Benzekri; Sophie Jacquier; Emmanuelle Mercier; Delphine Chartier; Charlotte Salmon; PierreFrançois Dequin; Francis Schneider; Guillaume Morel; Sylvie L’Hotellier; Julio Badie; Fernando Daniel Berdaguer; Sylvain Malfroy; Chaouki Mezher; Charlotte Bourgoin; Bruno Megarbane; Nicolas Deye; Isabelle Malissin; Laetitia Sutterlin; Christophe Guitton; Cédric Darreau; Mickaël Landais; Nicolas Chudeau; Alain Robert; Pierre Moine; Nicholas Heming; Virginie Maxime; Isabelle Bossard; Tiphaine Barbarin Nicholier; Gwenhael Colin; Vanessa Zinzoni; Natacham Maquigneau; André Finn; Gabriele Kreß; Uwe Hoff; Carl Friedrich Hinrichs; Jens Nee; Mathias Pletz; Stefan Hagel; Juliane Ankert; Steffi Kolanos; Frank Bloos; Sirak Petros; Bastian Pasieka; Kevin Kunz; Peter Appelt; Bianka Schütze; Stefan Kluge; Axel Nierhaus; Dominik Jarczak; Kevin Roedl; Dirk Weismann; Anna Frey; Vivantes Klinikum Neukölln; Lorenz Reill; Michael Distler; Astrid Maselli; János Bélteczki; István Magyar; Ágnes Fazekas; Sándor Kovács; Viktória Szőke; Gábor Szigligeti; János Leszkoven; Daniel Collins; Patrick Breen; Stephen Frohlich; Ruth Whelan; Bairbre McNicholas; Michael Scully; Siobhan Casey; Maeve Kernan; Peter Doran; Michael O’Dywer; Michelle Smyth; Leanne Hayes; Oscar Hoiting; Marco Peters; Els Rengers; Mirjam Evers; Anton Prinssen; Jeroen Bosch Ziekenhuis; Koen Simons; Wim Rozendaal; F Polderman; P de Jager; M Moviat; A Paling; A Salet; Emma Rademaker; Anna Linda Peters; E de Jonge; J Wigbers; E Guilder; M Butler; Keri-Anne Cowdrey; Lynette Newby; Yan Chen; Catherine Simmonds; Rachael McConnochie; Jay Ritzema Carter; Seton Henderson; Kym Van Der Heyden; Jan Mehrtens; Tony Williams; Alex Kazemi; Rima Song; Vivian Lai; Dinu Girijadevi; Robert Everitt; Robert Russell; Danielle Hacking; Ulrike Buehner; Erin Williams; Troy Browne; Kate Grimwade; Jennifer Goodson; Owen Keet; Owen Callender; Robert Martynoga; Kara Trask; Amelia Butler; Livia Schischka; Chelsea Young; Eden Lesona; Shaanti Olatunji; Yvonne Robertson; Nuno José; Teodoro Amaro dos Santos Catorze; Tiago Nuno Alfaro de Lima Pereira; Lucilia Maria Neves Pessoa; Ricardo Manuel Castro Ferreira; Joana Margarida Pereira Sousa Bastos; Simin Aysel Florescu; Delia Stanciu; Miahela Florentina Zaharia; Alma Gabriela Kosa; Daniel Codreanu; Yaseen Marabi; Eman Al Qasim; Mohamned Moneer Hagazy; Lolowa Al Swaidan; Hatim Arishi; Rosana Muñoz-Bermúdez; Judith Marin-Corral; Anna Salazar Degracia; Francisco Parrilla Gómez; Maria Isabel Mateo López; Jorge Rodriguez Fernandez; Sheila Cárcel Fernández; Rosario Carmona Flores; Rafael León López; Carmen de la Fuente Martos; Angela Allan; Petra Polgarova; Neda Farahi; Stephen McWilliam; Daniel Hawcutt; Laura Rad; Laura O’Malley; Jennifer Whitbread; Olivia Kelsall; Laura Wild; Jessica Thrush; Hannah Wood; Karen Austin; Adrian Donnelly; Martin Kelly; Sinéad O’Kane; Declan McClintock; Majella Warnock; Paul Johnston; Linda Jude Gallagher; Clare Mc Goldrick; Moyra Mc Master; Anna Strzelecka; Rajeev Jha; Michael Kalogirou; Christine Ellis; Vinodh Krishnamurthy; Vashish Deelchand; Jon Silversides; Peter McGuigan; Kathryn Ward; Aisling O’Neill; Stephanie Finn; Barbara Phillips; Dee Mullan; Laura Oritz-Ruiz de Gordoa; Matthew Thomas; Katie Sweet; Lisa Grimmer; Rebekah Johnson; Jez Pinnell; Matt Robinson; Lisa Gledhill; Tracy Wood; Matt Morgan; Jade Cole; Helen Hill; Michelle Davies; David Antcliffe; Maie Templeton; Roceld Rojo; Phoebe Coghlan; Joanna Smee; Euan Mackay; Jon Cort; Amanda Whileman; Thomas Spencer; Nick Spittle; Vidya Kasipandian; Amit Patel; Suzanne Allibone; Roman Mary Genetu; Mohamed Ramali; Alison Ghosh; Peter Bamford; Emily London; Kathryn Cawley; Maria Faulkner; Helen Jeffrey; Tim Smith; Chris Brewer; Jane Gregory; James Limb; Amanda Cowton; Julie O’Brien; Nikitas Nikitas; Colin Wells; Liana Lankester; Mark Pulletz; Patricia Williams; Jenny Birch; Sophie Wiseman; Sarah Horton; Ana Alegria; Salah Turki; Tarek Elsefi; Nikki Crisp; Louise Allen; Iain McCullagh; Philip Robinson; Carole Hays; Maite Babio-Galan; Hannah Stevenson; Divya Khare; Meredith Pinder; Selvin Selvamoni; Amitha Gopinath; Richard Pugh; Daniel Menzies; Callum Mackay; Elizabeth Allan; Gwyneth Davies; Kathryn Puxty; Claire McCue; Susanne Cathcart; Naomi Hickey; Jane Ireland; Hakeem Yusuff; Graziella Isgro; Chris Brightling; Michelle Bourne; Michelle Craner; Malcolm Watters; Rachel Prout; Louisa Davies; Suzannah Pegler; Lynsey Kyeremeh; Gill Arbane; Karen Wilson; Linda Gomm; Federica Francia; Stephen Brett; Sonia Sousa Arias; Rebecca Elin Hall; Joanna Budd; Charlotte Small; Janine Birch; Emma Collins; Jeremy Henning; Stephen Bonner; Keith Hugill; Emanuel Cirstea; Dean Wilkinson; Michal Karlikowski; Helen Sutherland; Elva Wilhelmsen; Jane Woods; Julie North; Dhinesh Sundaran; Laszlo Hollos; Susan Coburn; Joanne Walsh; Margaret Turns; Phil Hopkins; John Smith; Harriet Noble; Maria Theresa Depante; Emma Clarey; Shondipon Laha; Mark Verlander; Alexandra Williams; Abby Huckle; Andrew Hall; Jill Cooke; Caroline Gardiner-Hill; Carolyn Maloney; Hafiz Qureshi; Neil Flint; Sarah Nicholson; Sara Southin; Andrew Nicholson; Barbara Borgatta; Ian Turner-Bone; Amie Reddy; Laura Wilding; Loku Chamara Warnapura; Ronan Agno Sathianathan; David Golden; Ciaran Hart; Jo Jones; Jonathan Bannard-Smith; Joanne Henry; Katie Birchall; Fiona Pomeroy; Rachael Quayle; Arystarch Makowski; Beata Misztal; Iram Ahmed; Thyra KyereDiabour; Kevin Naiker; Richard Stewart; Esther Mwaura; Louise Mew; Lynn Wren; Felicity Willams; Richard Innes; Patricia Doble; Joanne Hutter; Charmaine Shovelton; Benjamin Plumb; Tamas Szakmany; Vincent Hamlyn; Nancy Hawkins; Sarah Lewis; Amanda Dell; Shameer Gopal; Saibal Ganguly; Andrew Smallwood; Nichola Harris; Stella Metherell; Juan Martin Lazaro; Tabitha Newman; Simon Fletcher; Jurgens Nortje; Deirdre Fottrell-Gould; Georgina Randell; Mohsin Zaman; Einas Elmahi; Andrea Jones; Kathryn Hall; Gary Mills; Kim Ryalls; Helen Bowler; Jas Sall; Richard Bourne; Zoe Borrill; Tracey Duncan; Thomas Lamb; Joanne Shaw; Claire Fox; Jeronimo Moreno Cuesta; Kugan Xavier; Dharam Purohit; Munzir Elhassan; Dhanalakshmi Bakthavatsalam; Matthew Rowland; Paula Hutton; Archana Bashyal; Neil Davidson; Clare Hird; Manish Chhablani; Gunjan Phalod; Amy Kirkby; Simon Archer; Kimberley Netherton; Henrik Reschreiter; Julie Camsooksai; Sarah Patch; Sarah Jenkins; David Pogson; Steve Rose; Zoe Daly; Lutece Brimfield; Helen Claridge; Dhruv Parekh; Colin Bergin; Michelle Bates; Joanne Dasgin; Christopher McGhee; Malcolm Sim; Sophie Kennedy Hay; Steven Henderson; Mandeep-Kaur Phull; Abbas Zaidi; Tatiana Pogreban; Lace Paulyn Rosaroso; Daniel Harvey; Benjamin Lowe; Megan Meredith; Lucy Ryan; Anil Hormis; Rachel Walker; Dawn Collier; Sarah Kimpton; Susan Oakley; Kevin Rooney; Natalie Rodden; Emma Hughes; Nicola Thomson; Deborah McGlynn; Andrew Walden; Nicola Jacques; Holly Coles; Emma Tilney; Emma Vowell; Martin Schuster-Bruce; Sally Pitts; Rebecca Miln; Laura Purandare; Luke Vamplew; Michael Spivey; Sarah Bean; Karen Burt; Lorraine Moore; Christopher Day; Charly Gibson; Elizabeth Gordon; Letizia Zitter; Samantha Keenan; Evelyn Baker; Shiney Cherian; Sean Cutler; Anna Roynon-Reed; Kate Harrington; Ajay Raithatha; Kris Bauchmuller; Norfaizan Ahmad; Irina Grecu; Dawn Trodd; Jane Martin; Caroline Wrey Brown; Ana-Marie Arias; Thomas Craven; David Hope; Jo Singleton; Sarah Clark; Nicola Rae; Ingeborg Welters; David Oliver Hamilton; Karen Williams; Victoria Waugh; David Shaw; Zudin Puthucheary; Timothy Martin; Filipa Santos; Ruzena Uddin; Alastair Somerville; Kate Colette Tatham; Shaman Jhanji; Ethel Black; Arnold Dela Rosa; Ryan Howle; Redmond Tully; Andrew Drummond; Joy Dearden; Jennifer Philbin; Sheila Munt; Alain Vuylsteke; Charles Chan; Saji Victor; Ramprasad Matsa; Minerva Gellamucho; Ben Creagh-Brown; Joe Tooley; Laura Montague; Fiona De Beaux; Laetitia Bullman; Ian Kersiake; Carrie Demetriou; Sarah Mitchard; Lidia Ramos; Katie White; Phil Donnison; Maggie Johns; Ruth Casey; Lehentha Mattocks; Sarah Salisbury; Paul Dark; Andrew Claxton; Danielle McLachlan; Kathryn Slevin; Stephanie Lee; Jonathan Hulme; Sibet Joseph; Fiona Kinney; Ho Jan Senya; Aneta Oborska; Abdul Kayani; Bernard Hadebe; Rajalakshmi Orath Prabakaran; Lesley Nichols; Matt Thomas; Ruth Worner; Beverley Faulkner; Emma Gendall; Kati Hayes; Colin Hamilton-Davies; Carmen Chan; Celina Mfuko; Hakam Abbass; Vineela Mandadapu; Susannah Leaver; Daniel Forton; Kamal Patel; Elankumaran Paramasivam; Matthew Powell; Richard Gould; Elizabeth Wilby; Clare Howcroft; Dorota Banach; Ziortza Fernández de Pinedo Artaraz; Leilani Cabreros; Ian White; Maria Croft; Nicky Holland; Rita Pereira; Ahmed Zaki; David Johnson; Matthew Jackson; Hywel Garrard; Vera Juhaz; Alistair Roy; Anthony Rostron; Lindsey Woods; Sarah Cornell; Suresh Pillai; Rachel Harford; Tabitha Rees; Helen Ivatt; Ajay Sundara Raman; Miriam Davey; Kelvin Lee; Russell Barber; Manish Chablani; Farooq Brohi; Vijay Jagannathan; Michele Clark; Sarah Purvis; Bill Wetherill; Ahilanandan Dushianthan; Rebecca Cusack; Kim de Courcy-Golder; Simon Smith; Susan Jackson; Ben Attwood; Penny Parsons; Valerie Page; Xiao Bei Zhao; Deepali Oza; Jonathan Rhodes; Tom Anderson; Sheila Morris; Charlotte Xia Le Tai; Amy Thomas; Alexandra Keen; Stephen Digby; Nicholas Cowley; Laura Wild; David Southern; Harsha Reddy; Andy Campbell; Claire Watkins; Sara Smuts; Omar Touma; Nicky Barnes; Peter Alexander; Tim Felton; Susan Ferguson; Katharine Sellers; Joanne Bradley-Potts; David Yates; Isobel Birkinshaw; Kay Kell; Nicola Marshall; Lisa Carr-Knott; Charlotte Summers Journal: JAMA Date: 2020-10-06 Impact factor: 56.272
Authors: Fernanda Meira; Estela Moreno-García; Laura Linares; Irene Macaya; Adria Tomé; Marta Hernández-Meneses; Laia Albiach; Laura Morata; Laura Letona; Marta Bodro; Alberto Cózar-Llistó; Celia Cardozo; Mariana Chumbita; Cristina Pitart; Juan Ambrosioni; Verónica Rico; Daiana Agüero; Pedro Puerta-Alcalde; Nicole Garcia-Pouton; Francesc Marco; Carolina Garcia-Vidal; Alex Soriano; José Antonio Martínez Journal: Infect Dis Ther Date: 2021-06-11
Authors: Karim Asehnoune; Charlene Le Moal; Gilles Lebuffe; Marguerite Le Penndu; Nolwen Chatel Josse; Matthieu Boisson; Thomas Lescot; Marion Faucher; Samir Jaber; Thomas Godet; Marc Leone; Cyrus Motamed; Jean Stephane David; Raphael Cinotti; Younes El Amine; Darius Liutkus; Matthias Garot; Antoine Marc; Anne Le Corre; Alexandre Thomasseau; Alexandra Jobert; Laurent Flet; Fanny Feuillet; Morgane Pere; Emmanuel Futier; Antoine Roquilly Journal: BMJ Date: 2021-06-02
Authors: Dong-Yi Hsieh; Yun-Ru Lai; Chia-Yi Lien; Wen-Neng Chang; Chih-Cheng Huang; Ben-Chung Cheng; Chia-Te Kung; Cheng-Hsien Lu Journal: Int J Environ Res Public Health Date: 2021-06-12 Impact factor: 3.390