{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T07:30:28Z","timestamp":1773819028307,"version":"3.50.1"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Metabolic dysfunction-associated steatotic liver disease (MASLD), is a common liver disorder, predicted to increase globally. Currently, non-invasive methods are proposed for the assessment of (MASLD). This study aimed to investigate the use of serum Liver Type Fatty Acid Binding Protein (L-FABP) concentration as a diagnostic and prognostic biomarker in pediatric MASLD patients and to evaluate its relationship with steatosis and fibrosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An observational, cross-sectional study on paediatric MASLD patients. Serum levels of L-FABP and hepatic biochemical markers were measured and analyzed. Statistical analyses evaluated the association between L-FABP and other markers, while logistic regression and ROC curves assessed its diagnostic accuracy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Serum L-FABP levels showed a significant difference between the MASLD and control groups <jats:italic><jats:italic>(P\u2009&lt;\u20090.0001).<\/jats:italic><\/jats:italic> The results of logistic regression revealed that each one-unit elevation of L-FABP level was associated with 144.5% higher odds of being MASLD (95% CI: 129.3% \u2212 167.8%). A receiver operating characteristics (ROC) curve was constructed to assess the diagnostic accuracy of L-FABP. The resulted area under the ROC curve (AUC) was 0.885. The cutoff value was 5.7\u2009ng\/ mL, with sensitivity of 72.73%, and a specificity of 93.62%. The results also showed that the odds ratio of progressing from stage F2 to F3 increases by 108.9% (95% CI: 87.2% \u2212 141.4%) for each one-unit increase in serum L-FABP level.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>L-FABP shows promise as a non-invasive biomarker for diagnosing and monitoring MASLD in pediatric patients. Its association with disease stages suggests its utility in assessing disease progression, particularly in advanced stages.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333581","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T17:48:03Z","timestamp":1759254483000},"page":"e0333581","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating liver type fatty acid binding protein as a diagnostic and prognostic biomarker in metabolic dysfunction-associated steatotic liver disease in pediatric patients"],"prefix":"10.1371","volume":"20","author":[{"given":"Nadia","family":"Al Mazrouei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mostafa Mohsen","family":"ElGharbawy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahitab","family":"Gamal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaimaa","family":"Emad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amal Ahmed","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osama Mohamed","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asim Ahmed","family":"Elnour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5032-8627","authenticated-orcid":true,"given":"Marafi Jammaa","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Semira Abdi","family":"Beshir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vineetha","family":"Menon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami Fatehi","family":"Abdalla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3524-4825","authenticated-orcid":true,"given":"Ali Awadallah","family":"Saeed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heba Ali","family":"ElRamly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"pone.0333581.ref001","article-title":"Non-alcoholic fatty liver disease: Definition and subtypes","volume":"29","author":"SK Han","year":"2023","journal-title":"Clin Mol Hepatol"},{"issue":"2","key":"pone.0333581.ref002","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/jdi.13678","article-title":"Metabolic associated fatty liver disease is a risk factor for chronic kidney disease","volume":"13","author":"Y Hashimoto","year":"2022","journal-title":"Journal of Diabetes Investigation"},{"issue":"4","key":"pone.0333581.ref003","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1159\/000539371","article-title":"EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)","volume":"17","author":"EA Liver","year":"2024","journal-title":"Obesity Facts"},{"issue":"3","key":"pone.0333581.ref004","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/apt.17096","article-title":"Meta\u2010analysis: global prevalence, trend and forecasting of non\u2010alcoholic fatty liver disease in children and adolescents, 2000\u20132021","volume":"56","author":"J Li","year":"2022","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0333581.ref005","article-title":"The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis","author":"K Riazi","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"1","key":"pone.0333581.ref006","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention","volume":"15","author":"Z Younossi","year":"2018","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"1","key":"pone.0333581.ref007","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgast-2021-000780","article-title":"Prevalence of and risk factors for non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt","volume":"8","author":"S Tomah","year":"2021","journal-title":"BMJ Open Gastroenterol"},{"issue":"2","key":"pone.0333581.ref008","first-page":"295","article-title":"The Influence Of Resistin (rs1862513) Gene Single Nucleotide Polymorphism In Egyptian Patients With Nonalcoholic Fatty Liver Disease","volume":"67","author":"MM El-Sayed","year":"2024","journal-title":"Egyptian Journal of Chemistry"},{"issue":"42","key":"pone.0333581.ref009","doi-asserted-by":"crossref","first-page":"15532","DOI":"10.3748\/wjg.v20.i42.15532","article-title":"Liver transplantation and non-alcoholic fatty liver disease","volume":"20","author":"P Zezos","year":"2014","journal-title":"World J Gastroenterol"},{"issue":"5","key":"pone.0333581.ref010","doi-asserted-by":"crossref","first-page":"100322","DOI":"10.1016\/j.jhepr.2021.100322","article-title":"Non-alcoholic fatty liver disease: A patient guideline","volume":"3","author":"SM Francque","year":"2021","journal-title":"JHEP Reports"},{"issue":"11","key":"pone.0333581.ref011","first-page":"1961","article-title":"Nonalcoholic fatty liver disease","volume":"73","author":"M Bayard","year":"2006","journal-title":"Am Fam Physician"},{"issue":"10","key":"pone.0333581.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0286586","article-title":"Clinical epidemiology of non-alcoholic fatty liver disease in children and adolescents. The LiverKids: Study protocol","volume":"18","author":"C Chac\u00f3n","year":"2023","journal-title":"PLoS One"},{"issue":"4","key":"pone.0333581.ref013","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1002\/hep.21346","article-title":"Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease","volume":"44","author":"RB Merriman","year":"2006","journal-title":"Hepatology"},{"issue":"2","key":"pone.0333581.ref014","doi-asserted-by":"crossref","first-page":"475","DOI":"10.3748\/wjg.v20.i2.475","article-title":"Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease\/nonalcoholic steatohepatitis","volume":"20","author":"Y Sumida","year":"2014","journal-title":"World J Gastroenterol"},{"issue":"2","key":"pone.0333581.ref015","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4291\/wjgp.v8.i2.11","article-title":"Nonalcoholic fatty liver disease: Diagnostic biomarkers","volume":"8","author":"F Hadizadeh","year":"2017","journal-title":"World J Gastrointest Pathophysiol"},{"key":"pone.0333581.ref016","doi-asserted-by":"crossref","first-page":"101167","DOI":"10.1016\/j.molmet.2021.101167","article-title":"Imaging biomarkers of NAFLD, NASH, and fibrosis","volume":"50","author":"V Ajmera","year":"2021","journal-title":"Mol Metab"},{"issue":"2","key":"pone.0333581.ref017","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/liv.14669","article-title":"Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events: A systematic review","volume":"41","author":"J Lee","year":"2021","journal-title":"Liver Int"},{"issue":"4","key":"pone.0333581.ref018","article-title":"The importance of liver-fatty acid binding protein in diagnosis of liver damage in patients with acute hepatitis","volume":"11","author":"OO Cakir","year":"2017","journal-title":"J Clin Diagn Res"},{"issue":"1","key":"pone.0333581.ref019","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/liv.13174","article-title":"Elevated levels of circulating CDH5 and FABP1 in association with human drug-induced liver injury","volume":"37","author":"M Mikus","year":"2017","journal-title":"Liver Int"},{"issue":"1","key":"pone.0333581.ref020","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s11095-021-02998-x","article-title":"The Role of Elevated Liver-Type Fatty Acid-Binding Proteins in Liver Diseases","volume":"38","author":"A Eguchi","year":"2021","journal-title":"Pharm Res"},{"key":"pone.0333581.ref021","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00508-014-0680-8","article-title":"Liver fatty acid-binding protein as a diagnostic marker for non-alcoholic fatty liver disease","volume":"128","author":"E Akbal","year":"2016","journal-title":"Wien Klin Wochenschr"},{"issue":"6","key":"pone.0333581.ref022","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1002\/hep4.1350","article-title":"Serum Liver-Type Fatty Acid-Binding Protein Is a Possible Prognostic Factor in Human Chronic Liver Diseases From Chronic Hepatitis to Liver Cirrhosis and Hepatocellular Carcinoma","volume":"3","author":"A Eguchi","year":"2019","journal-title":"Hepatol Commun"},{"issue":"1","key":"pone.0333581.ref023","doi-asserted-by":"crossref","first-page":"9","DOI":"10.5114\/ceh.2025.149075","article-title":"The importance of elastography in hepatological diagnostics in children","volume":"11","author":"E \u0141\u0119\u017cyk-Ciemniak","year":"2025","journal-title":"Clin Exp Hepatol"},{"issue":"6","key":"pone.0333581.ref024","first-page":"1","article-title":"Use of fibroscan liver elastography in the rapid diagnosis and monitoring of masld treatment","volume":"9","author":"R P","year":"2024","journal-title":"Annals of Case Reports"},{"key":"pone.0333581.ref025","doi-asserted-by":"crossref","first-page":"4627","DOI":"10.2147\/DMSO.S492809","article-title":"Protocol for a longitudinal cohort study to understand characteristics and risk factors underlying vibration-controlled transient elastography-diagnosed metabolic dysfunction-associated fatty liver disease children","author":"F Yang","year":"2024","journal-title":"Diabetes, Metabolic Syndrome and Obesity"},{"issue":"5","key":"pone.0333581.ref026","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1177\/0962280210374532","article-title":"A limitation of the diagnostic-odds ratio in determining an optimal cut-off value for a continuous diagnostic test","volume":"20","author":"D B\u00f6hning","year":"2011","journal-title":"Stat Methods Med Res"},{"issue":"2","key":"pone.0333581.ref027","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/MPG.0b013e31821b4b61","article-title":"Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD","volume":"53","author":"A Shannon","year":"2011","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"15","key":"pone.0333581.ref028","doi-asserted-by":"crossref","first-page":"4581","DOI":"10.3390\/jcm11154581","article-title":"Role of Ultrasound Methods for the Assessment of NAFLD","volume":"11","author":"G Petzold","year":"2022","journal-title":"J Clin Med"},{"issue":"15","key":"pone.0333581.ref029","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.3390\/diagnostics14151652","article-title":"Efficacy of Ultrasound for the Detection of Possible Fatty Liver Disease in Children","volume":"14","author":"SB Lowry","year":"2024","journal-title":"Diagnostics (Basel)"},{"issue":"4","key":"pone.0333581.ref030","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1373\/clinchem.2006.081257","article-title":"Higher concentrations of alanine aminotransferase within the reference interval predict nonalcoholic fatty liver disease","volume":"53","author":"Y Chang","year":"2007","journal-title":"Clin Chem"},{"issue":"6","key":"pone.0333581.ref031","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1365-2362.2005.01502.x","article-title":"Liver alanine aminotransferase, insulin resistance and endothelial dysfunction in normotriglyceridaemic subjects with type 2 diabetes mellitus","volume":"35","author":"RK Schindhelm","year":"2005","journal-title":"Eur J Clin Invest"},{"issue":"5","key":"pone.0333581.ref032","first-page":"637","article-title":"Non-alcoholic steatohepatitis and metabolic syndrome","volume":"9","author":"M Machado","year":"2006","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"3","key":"pone.0333581.ref033","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1440-1746.2007.04824.x","article-title":"Non-alcoholic fatty liver disease: further expression of the metabolic syndrome","volume":"22","author":"G Tarantino","year":"2007","journal-title":"J Gastroenterol Hepatol"},{"issue":"8","key":"pone.0333581.ref034","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1631\/jzus.B0720016","article-title":"Relationship between alanine aminotransferase levels and metabolic syndrome in nonalcoholic fatty liver disease","volume":"9","author":"Z Chen","year":"2008","journal-title":"J Zhejiang Univ Sci B"},{"issue":"2","key":"pone.0333581.ref035","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1002\/hep.21248","article-title":"Statins and hepatic steatosis: perspectives from the Dallas Heart Study","volume":"44","author":"JD Browning","year":"2006","journal-title":"Hepatology"},{"issue":"1","key":"pone.0333581.ref036","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/hep.20734","article-title":"Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study","volume":"42","author":"G Bedogni","year":"2005","journal-title":"Hepatology"},{"issue":"2","key":"pone.0333581.ref037","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/j.1572-0241.2006.01041.x","article-title":"Nonalcoholic fatty liver disease in severely obese subjects","volume":"102","author":"PM Gholam","year":"2007","journal-title":"Am J Gastroenterol"},{"issue":"3","key":"pone.0333581.ref038","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1002\/jpn3.12040","article-title":"Alanine aminotransferase cutoffs for the pediatric fatty liver disease: Major impact of the reference population","volume":"78","author":"L Aitokari","year":"2024","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"pone.0333581.ref039","volume-title":"Liver Function Tests","author":"V Lala","year":"2023"},{"issue":"5","key":"pone.0333581.ref040","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1111\/dom.14322","article-title":"Nonalcoholic fatty liver disease as a metabolic disease in humans: A literature review","volume":"23","author":"B Cariou","year":"2021","journal-title":"Diabetes Obes Metab"},{"issue":"9","key":"pone.0333581.ref041","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1038\/s41575-021-00448-y","article-title":"The complex link between NAFLD and type 2 diabetes mellitus - mechanisms and treatments","volume":"18","author":"G Targher","year":"2021","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"1","key":"pone.0333581.ref042","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.clinre.2018.08.007","article-title":"Association of glycated hemoglobin with the risk of advanced fibrosis in non-alcoholic fatty liver disease patients without diabetes","volume":"43","author":"C Yu","year":"2019","journal-title":"Clin Res Hepatol Gastroenterol"},{"issue":"5","key":"pone.0333581.ref043","doi-asserted-by":"crossref","DOI":"10.1210\/clinem\/dgaa112","article-title":"Glycemic Measures and Development and Resolution of Nonalcoholic Fatty Liver Disease in Nondiabetic Individuals","volume":"105","author":"B Wang","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0333581.ref044","doi-asserted-by":"crossref","first-page":"154752","DOI":"10.1016\/j.metabol.2021.154752","article-title":"Statin use is associated with lower prevalence of advanced liver fibrosis in patients with type 2 diabetes","volume":"121","author":"S Ciardullo","year":"2021","journal-title":"Metabolism"},{"issue":"1","key":"pone.0333581.ref045","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/s12902-022-01134-z","article-title":"Association of glycated hemoglobin with non-alcoholic fatty liver disease patients and the severity of liver steatosis and fibrosis measured by transient elastography in adults without diabetes","volume":"22","author":"Y Xie","year":"2022","journal-title":"BMC Endocr Disord"},{"issue":"2","key":"pone.0333581.ref046","doi-asserted-by":"crossref","first-page":"182","DOI":"10.7150\/ijms.40417","article-title":"Circulating fatty acid-binding protein 1 (FABP1) and nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus","volume":"17","author":"Y-C Lu","year":"2020","journal-title":"Int J Med Sci"},{"issue":"1","key":"pone.0333581.ref047","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"ZM Younossi","year":"2016","journal-title":"Hepatology"},{"issue":"31","key":"pone.0333581.ref048","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000026835","article-title":"Decline in serum albumin concentration is a predictor of serious events in nonalcoholic fatty liver disease","volume":"100","author":"K Kawaguchi","year":"2021","journal-title":"Medicine (Baltimore)"},{"issue":"9","key":"pone.0333581.ref049","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1111\/j.1872-034X.2010.00704.x","article-title":"Lower circulating levels of dehydroepiandrosterone, independent of insulin resistance, is an important determinant of severity of non-alcoholic steatohepatitis in Japanese patients","volume":"40","author":"Y Sumida","year":"2010","journal-title":"Hepatol Res"},{"issue":"7","key":"pone.0333581.ref050","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1007\/s10620-012-2098-3","article-title":"The spontaneous course of liver enzymes and its correlation in nonalcoholic fatty liver disease","volume":"57","author":"P Charatcharoenwitthaya","year":"2012","journal-title":"Dig Dis Sci"},{"issue":"4","key":"pone.0333581.ref051","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1111\/j.1478-3231.2005.01064.x","article-title":"Hyaluronic acid, an accurate serum marker for severe hepatic fibrosis in patients with non-alcoholic fatty liver disease","volume":"25","author":"A Suzuki","year":"2005","journal-title":"Liver Int"},{"issue":"9","key":"pone.0333581.ref052","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1111\/j.1440-1746.2006.04447.x","article-title":"Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease","volume":"21","author":"H Kaneda","year":"2006","journal-title":"J Gastroenterol Hepatol"},{"issue":"5","key":"pone.0333581.ref053","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1038\/ajg.2016.453","article-title":"Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis","volume":"112","author":"S McPherson","year":"2017","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"pone.0333581.ref054","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.arcmed.2012.11.007","article-title":"Liver fatty acid-binding protein is a diagnostic marker to detect liver injury due to chronic hepatitis C infection","volume":"44","author":"E Akbal","year":"2013","journal-title":"Arch Med Res"},{"issue":"1","key":"pone.0333581.ref055","doi-asserted-by":"crossref","first-page":"5345","DOI":"10.21608\/ejhm.2023.305534","article-title":"Liver Fatty Acid-binding Protein (L-FABP) as a Diagnostic Marker for Non-alcoholic Fatty Liver Disease","volume":"91","author":"SAM Bahnasawy","year":"2023","journal-title":"The Egyptian Journal of Hospital Medicine"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T17:48:12Z","timestamp":1759254492000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333581"}},"subtitle":[],"editor":[{"given":"Anna","family":"Di Sessa","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":55,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333581","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}