{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:40:52Z","timestamp":1790736052018,"version":"4.1.0"},"reference-count":58,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research and Development Foundation of Peking University People\u2019s Hospital","award":["RDL2024-11"],"award-info":[{"award-number":["RDL2024-11"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Hypotension is a common complication following spinal anesthesia, and it is particularly prevalent in older patients. The study aimed to develop and validate a nomogram integrating echocardiographic and clinical predictors for spinal anesthesia-induced hypotension (SAIH) in older patients. Methods: This was an observational cohort study conducted at Peking University People\u2019s Hospital. A total of 865 older patients (age \u2265 65), enrolled from 1 January 2023 to 31 December 2024, were randomly split into a training set (70%) and an internal validation set (30%). For temporal external validation, 349 patients from January to March 2025 were enrolled. LASSO, univariable, and multivariate logistic regression analyses were used to identify predictive factors. A nomogram was subsequently developed based on the results of multivariate logistic regression, and its predictive efficacy was evaluated via both internal and temporal external validation. Results: SAIH occurred in 271 patients (44.8%) in the training set, 110 patients (42.3%) in the internal validation set, and 173 patients (49.6%) in the external validation set. Age, body mass index (BMI), bupivacaine dose, sensory block level, baseline systolic blood pressure (SBP), history of hypertension, interventricular septum thickness at end-diastole (IVSd), early diastolic mitral annular velocity (e\u2019), and E\/e\u2019 ratio were significant predictors of SAIH on multivariate analysis. The diagnostic performance of the nomogram was favorable (AUC = 0.885, 95% CI: 0.859\u20130.911). The AUC values of the internal validation set and temporal external validation set were 0.856 (0.811\u20130.901) and 0.895 (0.863\u20130.927). Conclusions: This study identifies age, BMI, bupivacaine dose, sensory block level, baseline SBP, history of hypertension, and IVSd as predictors of SAIH with good discrimination and clinical utility. We present a predictive nomogram that accurately predicts SAIH in older patients. The external validation illustrates its generalizability.<\/jats:p>","DOI":"10.3390\/diagnostics16040557","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:52:21Z","timestamp":1770979941000},"page":"557","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Nomogram for Predicting the Risk of Spinal Anesthesia-Induced Hypotension in Older Patients"],"prefix":"10.3390","volume":"16","author":[{"given":"Bingyi","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zitian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoyu","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bailin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1213\/00000539-200206000-00027","article-title":"The Incidence and Risk Factors for Hypotension after Spinal Anesthesia Induction: An Analysis with Automated Data Collection","volume":"94","author":"Hartmann","year":"2002","journal-title":"Anesth. Analg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s44158-022-00047-6","article-title":"Spinal Anesthesia and Hypotensive Events in Hip Fracture Surgical Repair in Elderly Patients: A Meta-Analysis","volume":"2","author":"Messina","year":"2022","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/bja\/72.3.267","article-title":"Changes in Haemodynamic Variables during Transurethral Resection of the Prostate: Comparison of General and Spinal Anaesthesia","volume":"72","author":"Dobson","year":"1994","journal-title":"Br. J. Anaesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jclinane.2016.07.020","article-title":"Prophylactic Phenylephrine Infusion for the Prevention of Hypotension after Spinal Anesthesia in the Elderly: A Randomized Controlled Clinical Trial","volume":"35","author":"Marty","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1213\/01.ane.0000218421.18723.cf","article-title":"Spinal Anesthesia Using Single Injection Small-Dose Bupivacaine versus Continuous Catheter Injection Techniques for Surgical Repair of Hip Fracture in Elderly Patients","volume":"102","author":"Minville","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e32262","DOI":"10.1097\/MD.0000000000032262","article-title":"The Efficacy and Safety of Pre-Emptive Methoxamine Infusion in Preventing Hypotension by in Elderly Patients Receiving Spinal Anesthesia: A PRISMA-Compliant Protocol for Systematic Review and Meta-Analysis","volume":"101","author":"Li","year":"2022","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s11845-020-02175-w","article-title":"Hypotension during Hip Fracture Surgery and Postoperative Morbidity","volume":"189","author":"Beecham","year":"2020","journal-title":"Ir. J. Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/ALN.0000000000000686","article-title":"Intraoperative Mean Arterial Pressure Variability and 30-Day Mortality in Patients Having Noncardiac Surgery","volume":"123","author":"Mascha","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ijcard.2018.01.137","article-title":"Association between Intraoperative Hypotension and 30-Day Mortality, Major Adverse Cardiac Events, and Acute Kidney Injury after Non-Cardiac Surgery: A Meta-Analysis of Cohort Studies","volume":"258","author":"Gu","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.mpaic.2023.09.012","article-title":"Perioperative Transthoracic Echocardiography Applications in Orthogeriatric Patients","volume":"24","author":"Yip","year":"2023","journal-title":"Anaesth. Intensive Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1007\/s10877-023-00981-y","article-title":"Point of Care Transthoracic Echocardiography for the Prediction of Post\u2014Spinal Anesthesia Hypotension in Elderly Patients with Cardiac Diseases and Left Ventricular Dysfunction: Inferior Vena Cava and Post-Spinal Anesthesia Hypotension in Elderly Patients","volume":"37","author":"Moschovaki","year":"2023","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1053\/j.jvca.2019.02.032","article-title":"The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player","volume":"33","author":"Saranteas","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_13","first-page":"271","article-title":"Cardiovascular Effects of Low-Dose Spinal Anaesthesia as a Function of Age: An Observational Study Using Echocardiography","volume":"34","author":"Lairez","year":"2015","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1016\/S1470-2045(14)71116-7","article-title":"Nomograms in Oncology: More than Meets the Eye","volume":"16","author":"Balachandran","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/ALN.0b013e3182472320","article-title":"Intraoperative hypotension and perioperative ischemic stroke after general surgery: A nested case-control study","volume":"116","author":"Bijker","year":"2012","journal-title":"Anesthesiology"},{"key":"ref_16","first-page":"90","article-title":"SPINAL ANAESTHESIA-INDUCED HYPOTENSION IN OBSTETRICS: PREVENTION AND THERAPY","volume":"58","author":"Bujas","year":"2019","journal-title":"Acta Clin. Croat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1111\/j.1399-6576.2010.02239.x","article-title":"Definitions of Hypotension after Spinal Anaesthesia for Caesarean Section: Literature Search and Application to Parturients","volume":"54","author":"Roth","year":"2010","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1038\/nrcardio.2012.27","article-title":"Management of Hypertension in the Elderly","volume":"9","author":"Pimenta","year":"2012","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2230","DOI":"10.4103\/jfmpc.jfmpc_1959_20","article-title":"A Study of Risk Factors and Complications in Elderly Hypertensive Subjects","volume":"10","author":"Varghese","year":"2021","journal-title":"J. Family Med. Prim. Care"},{"key":"ref_20","first-page":"e69977","article-title":"A Comparative Study of Infusion of Ephedrine and Phenylephrine on Hemodynamic Stability After Spinal Anesthesia in Elderly Patients Undergoing Lower Limb Orthopedic Surgeries","volume":"16","author":"Ibrahim","year":"2024","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1093\/bja\/aex274","article-title":"Is Postspinal Hypotension a Sign of Impaired Cardiac Performance in the Elderly? An Observational Mechanistic Study","volume":"119","author":"Jakobsson","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s10396-021-01115-0","article-title":"Aging and Myocardial Strain","volume":"49","author":"Nakanishi","year":"2022","journal-title":"J. Med. Ultrason. (2001)"},{"key":"ref_23","first-page":"S58","article-title":"The Incidence and Risk Factors of Hypotension and Bradycardia Associated with Spinal Anesthesia","volume":"89","author":"Kyokong","year":"2006","journal-title":"J. Med. Assoc. Thai."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1111\/j.1399-6576.1992.tb03517.x","article-title":"A Regression Model for Identifying Patients at High Risk of Hypotension, Bradycardia and Nausea during Spinal Anesthesia","volume":"36","author":"Tarkkila","year":"1992","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_25","first-page":"e34198","article-title":"Incidence and Risk Factors of Spinal Anesthesia-Related Complications After an Elective Cesarean Section: A Retrospective Cohort Study","volume":"15","author":"Algarni","year":"2023","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/1467-8446.00044-i1","article-title":"Modifications of the Cardiovascular System with Aging","volume":"11","author":"Ferrari","year":"2002","journal-title":"Am. J. Geriatr. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/bja\/85.5.763","article-title":"The Aged Cardiovascular Risk Patient","volume":"85","author":"Priebe","year":"2000","journal-title":"Br. J. Anaesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1097\/00000542-199606000-00010","article-title":"Magnetic Resonance Imaging of Cerebrospinal Fluid Volume and the Influence of Body Habitus and Abdominal Pressure","volume":"84","author":"Hogan","year":"1996","journal-title":"Anesthesiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1213\/00000539-198507000-00012","article-title":"Distribution of Local Anesthetic Solutions within the Subarachnoid Space","volume":"64","author":"Greene","year":"1985","journal-title":"Anesth. Analg."},{"key":"ref_30","first-page":"127","article-title":"Body Mass and Spread of Spinal Anesthesia with Bupivacaine","volume":"66","year":"1987","journal-title":"Anesth. Analg."},{"key":"ref_31","first-page":"e984","article-title":"Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association","volume":"143","author":"Poirier","year":"2021","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.bpa.2017.01.001","article-title":"Spinal-Induced Hypotension: Incidence, Mechanisms, Prophylaxis, and Management: Summarizing 20 Years of Research","volume":"31","author":"Lee","year":"2017","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2147\/LRA.S240753","article-title":"Control of Spinal Anesthesia-Induced Hypotension in Adults","volume":"13","author":"Martin","year":"2020","journal-title":"Local Reg. Anesth."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.12659\/MSM.889412","article-title":"Spinal Anesthesia with Hyperbaric Bupivacaine: A Comparison of Hypertensive and Normotensive Patients","volume":"19","author":"Acar","year":"2013","journal-title":"Med. Sci. Monit."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/ACO.0000000000000712","article-title":"Low-Dose Spinal Anesthesia for Cesarean Section to Prevent Spinal-Induced Hypotension","volume":"32","year":"2019","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1111\/j.1755-5949.2012.00306.x","article-title":"Combination of Low-Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section","volume":"18","author":"Qiu","year":"2012","journal-title":"CNS Neurosci. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1111\/j.1365-2044.2005.04382.x","article-title":"A Procedure-Specific Systematic Review and Consensus Recommendations for Analgesia after Total Hip Replacement","volume":"60","author":"Fischer","year":"2005","journal-title":"Anaesthesia"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1213\/00000539-199205000-00018","article-title":"Role of Spinal Opioid Receptors in the Antinociceptive Interactions between Intrathecal Morphine and Bupivacaine","volume":"74","author":"Tejwani","year":"1992","journal-title":"Anesth. Analg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e7184","DOI":"10.1097\/MD.0000000000007184","article-title":"Level of Sensory Block after Spinal Anesthesia as a Predictor of Hypotension in Parturient","volume":"96","author":"Zhang","year":"2017","journal-title":"Medicine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s10286-024-01019-2","article-title":"The Relevance of the Superior Cervical Ganglion for Cardiac Autonomic Innervation in Health and Disease: A Systematic Review","volume":"34","author":"Chen","year":"2024","journal-title":"Clin. Auton. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1213\/01.ANE.0000149548.88029.A2","article-title":"The Effect of Posture and Baricity on the Spread of Intrathecal Bupivacaine for Elective Cesarean Delivery","volume":"100","author":"Hallworth","year":"2005","journal-title":"Anesth. Analg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1213\/01.ane.0000189049.11005.26","article-title":"The Sitting versus Right Lateral Position during Combined Spinal-Epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension","volume":"102","author":"Coppejans","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_43","first-page":"1127","article-title":"Incidence and Risk Factors of Hypotension during Spinal Anesthesia for Cesarean Section at Siriraj Hospital","volume":"89","author":"Chumpathong","year":"2006","journal-title":"J. Med. Assoc. Thai."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s005400200025","article-title":"Comparative Effect of 6% Hydroxyethyl Starch (Containing 1% Dextrose) and Lactated Ringer\u2019s Solution for Cesarean Section under Spinal Anesthesia","volume":"16","author":"Yorozu","year":"2002","journal-title":"J. Anesth."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s10877-016-9906-9","article-title":"Sympatho-Vagal Balance, as Quantified by ANSindex, Predicts Post Spinal Hypotension and Vasopressor Requirement in Parturients Undergoing Lower Segmental Cesarean Section: A Single Blinded Prospective Observational Study","volume":"31","author":"Prashanth","year":"2017","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1055\/s-0042-1759486","article-title":"Pathophysiology, Diagnosis, and Management of Hypertension in the Elderly","volume":"31","author":"Glazier","year":"2022","journal-title":"Int. J. Angiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1136\/rapm-00115550-198914020-00005","article-title":"A Comparison of Cardiovascular Responses of Normotensive and Hypertensive Elderly Patients Following Bupivacaine Spinal Anesthesia","volume":"14","author":"Racle","year":"1989","journal-title":"Reg. Anesth."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"193","DOI":"10.4103\/0253-7613.93847","article-title":"A Comparison of Hypotension and Bradycardia Following Spinal Anesthesia in Patients on Calcium Channel Blockers and \u03b2-Blockers","volume":"44","author":"Kaimar","year":"2012","journal-title":"Indian J. Pharmacol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/00000542-199408000-00006","article-title":"Influence of Chronic Angiotensin-Converting Enzyme Inhibition on Anesthetic Induction","volume":"81","author":"Coriat","year":"1994","journal-title":"Anesthesiology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1111\/j.0742-2822.2003.03038.x","article-title":"Current State of Intraoperative Echocardiography","volume":"20","author":"Katsnelson","year":"2003","journal-title":"Echocardiography"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1001\/jama.289.2.194","article-title":"Burden of Systolic and Diastolic Ventricular Dysfunction in the Community: Appreciating the Scope of the Heart Failure Epidemic","volume":"289","author":"Redfield","year":"2003","journal-title":"JAMA"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1161\/CIRCULATIONAHA.106.179918","article-title":"Heart Disease and Stroke Statistics--2007 Update: A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee","volume":"115","author":"Rosamond","year":"2007","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/ACO.0000000000000141","article-title":"Diastolic Dysfunction, Diagnostic and Perioperative Management in Cardiac Surgery","volume":"28","author":"Nicoara","year":"2015","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1016\/j.jacc.2016.12.037","article-title":"A Test in Context: E\/A and E\/e\u2019 to Assess Diastolic Dysfunction and LV Filling Pressure","volume":"69","author":"Mitter","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1093\/ehjci\/jew082","article-title":"Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"17","author":"Nagueh","year":"2016","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1136\/heartjnl-2018-314657","article-title":"Left Ventricular Geometry and Risk of Incident Hypertension","volume":"105","author":"Park","year":"2019","journal-title":"Heart"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Yang, Y., Li, Z., Guo, X., Zhou, Y., Chang, Y., Yang, H., Yu, S., Ouyang, N., Chen, S., and Sun, G. (2022). Interventricular Septum Thickness for the Prediction of Coronary Heart Disease and Myocardial Infarction in Hypertension Population: A Prospective Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237152"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/bja\/70.6.672","article-title":"Prevention and Treatment of Hypotension during Central Neural Block","volume":"70","author":"McCrae","year":"1993","journal-title":"Br. J. Anaesth."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/4\/557\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T11:10:10Z","timestamp":1770981010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/4\/557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":58,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["diagnostics16040557"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16040557","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}