{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T09:25:19Z","timestamp":1783329919480,"version":"3.54.6"},"reference-count":47,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The clinical utility of renal ultrasound after pediatric urinary tract infection (UTI) remains controversial, particularly because not all ultrasonographic abnormalities have the same prognostic significance. This study aimed to determine whether nephrourological malformations identify the phenotype associated with greater subsequent clinical burden among children hospitalized with presumed UTI and interpretable renal ultrasound findings, and to differentiate this phenotype from non-malformative ultrasound abnormalities. Methods: A retrospective single-center hospital-based cohort study was conducted in children aged 2 months to 17 years hospitalized with a clinical diagnosis of UTI at a general hospital of the Mexican Social Security Institute between 2020 and 2025. The cohort included both microbiologically confirmed UTI cases and probable clinical\/microbiologically unconfirmed UTI cases. Of 182 registered patients, 130 with interpretable renal ultrasound were included. The primary exposure was the presence of adjudicated nephrourological malformation. As a secondary exposure, within the subgroup without malformation, abnormal non-malformative ultrasound findings were compared with normal ultrasound findings. Outcomes included outpatient follow-up, subspecialty referral, and hospital readmission. Crude associations were expressed as relative risks (RR), and adjusted analyses were estimated using modified Poisson regression with HC3 robust errors. Results: Twenty-nine of 130 patients (22.31%) were classified as having nephrourological malformations, and 31 (23.85%) had abnormal non-malformative ultrasound findings. Malformations were associated with higher outpatient follow-up (79.31% vs. 44.55%; RR 1.78, 95% CI 1.34\u20132.37), greater subspecialty referral (79.31% vs. 49.50%; RR 1.60, 95% CI 1.22\u20132.10), and increased readmission (44.83% vs. 13.86%; RR 3.23, 95% CI 1.72\u20136.08). In adjusted models, malformations remained associated with follow-up (aRR 1.72, 95% CI 1.25\u20132.37), referral (aRR 1.59, 95% CI 1.17\u20132.16), and readmission (aRR 3.38, 95% CI 1.58\u20137.23). In contrast, abnormal non-malformative ultrasound findings showed no significant adjusted associations. Microbiologically confirmed UTI was present in 47\/130 patients (36.15%), and malformations were more frequent in this subgroup than in probable\/non-confirmed clinical UTI (34.04% vs. 15.66%; p = 0.027). Conclusions: In this single-center hospital-based cohort, subsequent clinical burden was concentrated in the nephrourological malformation phenotype rather than in the broader category of \u201cabnormal ultrasound\u201d. These findings suggest that renal ultrasound may serve as a useful prognostic stratification tool beyond its role as a nonspecific detector of abnormalities following pediatric UTI. Given the observational design, these associations should be confirmed in larger prospective studies.<\/jats:p>","DOI":"10.3390\/diagnostics16132109","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"2109","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Urological Malformations Identify the High-Burden Phenotype Among Children Hospitalized for Presumed Urinary Tract Infection: A Retrospective Cohort"],"prefix":"10.3390","volume":"16","author":[{"given":"Ana C.","family":"Esp\u00edritu-Mojarro","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Mexican Institute of Social Security (IMSS), General Hospital of Zone No. 1, Villa de Alvarez 28984, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4685-3095","authenticated-orcid":false,"given":"Gustavo A.","family":"Hern\u00e1ndez-Fuentes","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"},{"name":"State Cancerology Institute of Colima, Health Services of the Mexican Social Security Institute for Welfare (IMSS-BIENESTAR), Colima 28085, Mexico"},{"name":"Faculty of Chemical Sciences, University of Colima, Coquimatlan 28400, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela E.","family":"Pedroza-Orozco","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mexican Institute of Social Security (IMSS), General Hospital of Zone No. 1, Villa de Alvarez 28984, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6727-0051","authenticated-orcid":false,"given":"Jos\u00e9","family":"Guzm\u00e1n-Esquivel","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez 28984, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9826-1895","authenticated-orcid":false,"given":"Jes\u00fas","family":"Venegas-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Instituto Mexicano del Seguro Social (IMSS), Hospital de Zona No. 1, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ileana Y.","family":"Ceja-Claro","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mexican Institute of Social Security (IMSS), General Hospital of Zone No. 1, Villa de Alvarez 28984, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2748-4327","authenticated-orcid":false,"given":"Daniel A.","family":"Montes-Galindo","sequence":"additional","affiliation":[{"name":"Faculty of Chemical Sciences, University of Colima, Coquimatlan 28400, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3525-7821","authenticated-orcid":false,"given":"Carmen A.","family":"S\u00e1nchez-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Fuentes-Murguia","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1744-9173","authenticated-orcid":false,"given":"Fabian","family":"Rojas-Larios","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8702-0252","authenticated-orcid":false,"given":"Karmina","family":"S\u00e1nchez-Meza","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Ceja-Esp\u00edritu","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Del-Toro-Equihua","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9848-862X","authenticated-orcid":false,"given":"Iv\u00e1n","family":"Delgado-Enciso","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"},{"name":"State Cancerology Institute of Colima, Health Services of the Mexican Social Security Institute for Welfare (IMSS-BIENESTAR), Colima 28085, Mexico"},{"name":"Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"103","DOI":"10.18233\/apm.v46i1.3018","article-title":"Abordaje de Las Infecciones Del Tracto Urinario En Pediatr\u00eda","volume":"46","author":"Morales","year":"2025","journal-title":"Acta Pedi\u00e1tr. M\u00e9xico"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jped.2019.10.006","article-title":"Urinary Tract Infection in Pediatrics: An Overview","volume":"96","author":"Oliveira","year":"2020","journal-title":"J. Pediatr."},{"key":"ref_3","first-page":"288","article-title":"Diagnosis of Urinary Tract Infection in Infants under 3 Months with Fever without a Source: Reliability of Urinalysis and Urine Culture","volume":"80","year":"2023","journal-title":"Bol. Med. Hosp. Infant. M\u00e9xico"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.paed.2024.06.012","article-title":"Urinary Tract Infections in Children","volume":"34","author":"Barola","year":"2024","journal-title":"Paediatr. Child Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1128\/CMR.18.2.417-422.2005","article-title":"Diagnosis and Management of Pediatric Urinary Tract Infections","volume":"18","author":"Zorc","year":"2005","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2833","DOI":"10.1007\/s00467-024-06321-9","article-title":"Biomarkers for Urinary Tract Infection: Present and Future Perspectives","volume":"39","author":"Mattoo","year":"2024","journal-title":"Pediatr. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1038\/pr.2016.33","article-title":"Evaluation of Novel Urinary Tract Infection Biomarkers in Children","volume":"79","author":"Watson","year":"2016","journal-title":"Pediatr. Res."},{"key":"ref_8","unstructured":"Bono, M.J., Leslie, S.W., and Reygaert, W.C. (2025). Uncomplicated Urinary Tract Infections, StatPearls Publishing."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3051","DOI":"10.1128\/JCM.37.9.3051-3052.1999","article-title":"Evaluation of the Leukocyte Esterase and Nitrite Urine Dipstick Screening Tests for Detection of Bacteriuria in Women with Suspected Uncomplicated Urinary Tract Infections","volume":"37","author":"Semeniuk","year":"1999","journal-title":"J. Clin. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1001\/jamapediatrics.2023.1387","article-title":"Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children: A Systematic Review and Meta-Analysis","volume":"177","author":"Yang","year":"2023","journal-title":"JAMA Pediatr."},{"key":"ref_11","first-page":"1","article-title":"Imaging Investigation after Urinary Tract Infection in Childhood: Narrative Review of Current Recommendations","volume":"6","author":"Jabour","year":"2023","journal-title":"Pediatr. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s004670050243","article-title":"The Evaluation of Acute Pyelonephritis and Renal Scarring with Technetium 99m-Dimercaptosuccinic Acid Renal Scintigraphy: Evolving Concepts and Future Directions","volume":"11","author":"Rushton","year":"1997","journal-title":"Pediatr. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1542\/peds.2011-1330","article-title":"Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months","volume":"128","author":"Roberts","year":"2011","journal-title":"Pediatrics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6","DOI":"10.14740\/ijcp295e","article-title":"The Role of Renal Ultrasound in Children with Febrile Urinary Tract Infection","volume":"7","author":"Shabbeer","year":"2018","journal-title":"Int. J. Clin. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Brockwell, M., Hergenrother, S., Satariano, M., Shah, R., and Raina, R. (2024). Pathophysiology of Congenital Anomalies of the Kidney and Urinary Tract: A Comprehensive Review. Cells, 13.","DOI":"10.3390\/cells13221866"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s40746-019-00166-3","article-title":"Congenital Anomalies of the Kidney and Urinary Tract: A Clinical Review","volume":"5","author":"Stonebrook","year":"2019","journal-title":"Curr. Treat. Options Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1370\/afm.2684","article-title":"Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections: Systematic Review and Meta-Analysis","volume":"19","author":"Boon","year":"2021","journal-title":"Ann. Fam. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hansen, K.L., Nielsen, M.B., and Ewertsen, C. (2015). Ultrasonography of the Kidney: A Pictorial Review. Diagnostics, 6.","DOI":"10.3390\/diagnostics6010002"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1055\/a-2132-6573","article-title":"Ultrasound Diagnosis of Malformations of the Fetal Kidneys and Urinary System","volume":"45","author":"Heling","year":"2024","journal-title":"Ultraschall Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Leballo, G., Arbee-Kalidas, N., Kebalepile, M.M., and Chakane, P.M. (2025). The Use of Ultrasonography in the Diagnosis and Management of Acute Kidney Injury and Other Forms Renal Dysfunction in the Paediatric Population: Systematic Review Protocol. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0325549"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.earlhumdev.2005.11.003","article-title":"Prenatal Diagnosis and Management of Hydronephrosis","volume":"82","author":"Pates","year":"2006","journal-title":"Early Hum. Dev."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Farladansky-Gershnabel, S., Gluska, H., Meyer, S., Sharon-Weiner, M., Schreiber, H., Arnon, S., and Markovitch, O. (2023). Postnatal Outcomes of Fetuses with Prenatal Diagnosis of 6\u20139.9 Mm Pyelectasis. Children, 10.","DOI":"10.3390\/children10020407"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Becker, W., Meller, J., Zappel, H., Leenen, A., and Seseke, F. (2003). Imaging in Paediatric Urology, Springer.","DOI":"10.1007\/978-3-642-55785-9"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.4111\/icu.2017.58.S1.S4","article-title":"Il Genetics of Vesicoureteral Reflux and Congenital Anomalies of the Kidney and Urinary Tract","volume":"58","author":"Lee","year":"2017","journal-title":"Investig. Clin. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/S0022-3476(78)80621-0","article-title":"A Simplified Method for Diagnosis of Gestational Age in the Newborn Infant","volume":"93","author":"Capurro","year":"1978","journal-title":"J. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/j.1365-3016.2007.00858.x","article-title":"Menstrual versus Clinical Estimate of Gestational Age Dating in the United States: Temporal Trends and Variability in Indices of Perinatal Outcomes","volume":"21","author":"Ananth","year":"2007","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_27","unstructured":"Rosner, B. (2011). Fundamentals of Biostatistics, Brooks\/Cole, Cengage Learning. [7th ed.]."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/00006199-200401000-00009","article-title":"SPSS and SAS Programming for the Testing of Mediation Models","volume":"53","author":"Dudley","year":"2004","journal-title":"Nurs. Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki. JAMA, 310, 2191.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.4103\/sja.SJA_543_18","article-title":"The STROBE Guidelines","volume":"13","author":"Cuschieri","year":"2019","journal-title":"Saudi J. Anaesth."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1542\/hpeds.2025-008534","article-title":"Timing of Renal and Bladder Ultrasound After First Febrile Urinary Tract Infection: A Hospitalist Dilemma","volume":"16","author":"Marsh","year":"2026","journal-title":"Hosp. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.1111\/apa.70152","article-title":"Abnormal Ultrasound Findings After a Urinary Tract Infection in Children","volume":"114","author":"Hakkola","year":"2025","journal-title":"Acta Paediatr."},{"key":"ref_33","first-page":"e050126","article-title":"A Holistic Approach to CAKUT (Congenital Anomalies of the Kidney and Urinary Tract)","volume":"5","author":"Masnata","year":"2016","journal-title":"J. Pediatr. Neonatal Individ. Med. (JPNIM)"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Winyard, P.J.D., Napolitano, R., and Sebire, N.J. (2023). Normal Human Kidney Development and Congenital Anomalies of the Kidneys and Urinary Tract. Pediatric Nephropathology & Childhood Kidney Tumors, Cambridge University Press.","DOI":"10.1017\/9781108907224.002"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4103\/ua.ua_147_22","article-title":"Urinary Tract Infection in Children: A Narrative Review of Clinical Practice Guidelines","volume":"15","author":"Alsaywid","year":"2023","journal-title":"Urol. Ann."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3963","DOI":"10.1007\/s00467-023-05899-w","article-title":"Congenital Anomalies of the Kidney and Urinary Tract: Defining Risk Factors of Disease Progression and Determinants of Outcomes","volume":"38","author":"Walawender","year":"2023","journal-title":"Pediatr. Nephrol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Turcu, F.L., Vacaroiu, I.A., Balcangiu-Stroescu, A.E., Mitrea, A.R., Miricescu, D., Balan, D.G., and Stanigut, A.M. (2025). Recurrent Urinary Tract Infections in Female Patients\u2014A Clinical Review. J. Mind Med. Sci., 12.","DOI":"10.3390\/jmms12010005"},{"key":"ref_38","first-page":"1","article-title":"Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults","volume":"17","year":"2021","journal-title":"Curr. Bladder Dysfunct. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1007\/s00429-024-02833-0","article-title":"Sex-Related Variability of White Matter Tracts in the Whole HCP Cohort","volume":"229","author":"Herlin","year":"2024","journal-title":"Brain Struct. Funct."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Zhang, M., Su, Y., and Sun, Y.P. (2023). Gender Bias in Fetal Malformations: A Cross-Sectional Study in Asian Populations. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1146689"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1136\/adc.63.7.818","article-title":"Urinary Infection and Malformations of Urinary Tract in Infancy","volume":"63","author":"Ring","year":"1988","journal-title":"Arch. Dis. Child."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Buonsenso, D., Sodero, G., Camporesi, A., Pierucci, U.M., Raffaelli, F., Proli, F., Valentini, P., and Rendeli, C. (2024). Predictors of Urinary Abnormalities in Children Hospitalised for Their First Urinary Tract Infection. Children, 11.","DOI":"10.3390\/children11010055"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Lu, J., Liu, X., Wei, Y., Yu, C., Zhao, J., Wang, L., Hu, Y., Wei, G., and Wu, S. (2022). Clinical and Microbial Etiology Characteristics in Pediatric Urinary Tract Infection. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.844797"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s00345-011-0725-9","article-title":"Urinary Tract Infection Associated with Conditions Causing Urinary Tract Obstruction and Stasis, Excluding Urolithiasis and Neuropathic Bladder","volume":"30","author":"Heyns","year":"2012","journal-title":"World J. Urol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary Tract Infections: Epidemiology, Mechanisms of Infection and Treatment Options","volume":"13","author":"Walker","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Maringhini, S., Alaygut, D., and Corrado, C. (2024). Urinary Tract Infection in Children: An Up-To-Date Study. Biomedicines, 12.","DOI":"10.3390\/biomedicines12112582"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1097\/INF.0000000000004790","article-title":"Guidelines for Complicated Urinary Tract Infections in Children: A Review by the European Society for Pediatric Infectious Diseases","volume":"44","author":"Bryant","year":"2025","journal-title":"Pediatr. Infect. Dis. J."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2109\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T09:06:16Z","timestamp":1783328776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":47,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16132109"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16132109","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]}}}