ArticleFrontiers in endocrinology2026
Predicting sight-threatening diabetic retinopathy using the combination of serum cystatin C and indirect bilirubin.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To evaluate the predictive value of serum cystatin C and indirect bilirubin (IBIL), both individually and in combination, for sight-threatening diabetic retinopathy (STDR) in type 2 diabetes mellitus (T2DM). Methods: Retrospective cross-sectional study. Comprehensive demographic, clinical, and laboratory data were collected. Statistical analyses included between-group comparisons, univariable and multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Patients were stratified into cystatin C tertiles to examine dose-response relationships. Results: 151 T2DM patients (79 non-STDR, 72 STDR) recruited from two clinical centers. STDR patients showed significantly higher cystatin C (1.10 [0.91, 1.31] vs. 0.88 [0.80, 1.01] mg/L, P < 0.001) and lower IBIL levels (6.90 ± 3.89 vs. 9.72 ± 4.98 μmol/L, P < 0.001). Multivariable analysis confirmed cystatin C (OR = 1.342 per 0.1 mg/L increase, 95% CI 1.111-1.621, P = 0.002) and IBIL (OR = 1.139 per μmol/L decrease, 95% CI 1.031-1.259, P = 0.011) as independent STDR predictors. The highest cystatin C tertile had 7.576-fold increased STDR odds (95% CI 2.560-22.419, P < 0.001). ROC analysis showed cystatin C (>1.025 mg/L) predicted STDR with area under the receiver operating characteristic curve (AUROC)=0.737, while IBIL (<6.09 μmol/L) had AUROC = 0.667. Combination strategies provided flexible performance: "OR" rule (either high cystatin C or low IBIL) achieved 80.6% sensitivity, while "AND" rule (both high cystatin C and low IBIL) reached 94.9% specificity. Conclusions: Serum cystatin C and IBIL are independent predictors of STDR in T2DM. Their combination offers a flexible screening approach-achieving either high sensitivity or high specificity-providing a practical tool for risk stratification and early detection of STDR.
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