{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T20:46:06Z","timestamp":1754599566227,"version":"3.41.2"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Diabetic retinopathy (DR) not only leads to visual impairment but also increases the risk of death in type 2 diabetes patients. This study aimed to construct a nomogram to assess the risk of all-cause mortality in patients with DR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional study included 1004 patients from the National Health and Nutrition Examination Survey database (NHANES) between 1999-2018. Participants were randomized in a 7:3 ratio into a training set and a test set. We selected predictors by LASSO regression and multifactorial Cox proportional risk regression analysis and constructed nomograms, guided by established clinical guidelines and expert consensus as the gold standard. We used the concordance index (C-index), receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) to evaluate the nomogram\u2019s discriminative power, calibration quality, and clinical use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The training and test sets consisted of 703 and 301 participants with a median age of 64 and 63 years, respectively. The study identified seven predictors, including age, marital status, congestive heart failure (CHF), coronary heart disease (CHD), stroke, creatinine level, and taking insulin. The C-index of the nomogram model constructed from the training set was 0.738 (95% CI: 0.704-0.771), while the C-index of the test set was 0.716 (95% CI: 0.663-0.768). In the training set, the model\u2019s AUC values for predicting all-cause mortality risk at 3 years, 5 years, and 10 years were 0.739, 0.765, and 0.808, respectively. In the test set, these AUC values were 0.737, 0.717, and 0.732, respectively. The ROC curve, calibration curve, and DCA curve all demonstrated excellent predictive performance, confirming the model\u2019s effectiveness and reliability in clinical applications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our nomogram demonstrates high clinical predictive accuracy, enabling clinicians to effectively predict the overall mortality risk in patients with DR, thereby significantly improving their prognosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1493984","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T05:19:07Z","timestamp":1740115147000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Construction of a nomogram for predicting the risk of all-cause mortality in patients with diabetic retinopathy"],"prefix":"10.3389","volume":"16","author":[{"given":"Wenwei","family":"Zuo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuelian","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2023.2558","article-title":"Diabetic retinopathy in the us-where we are now and what is next","volume":"141","author":"Kong","year":"2023","journal-title":"JAMA Ophthalmol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis","volume":"128","author":"Teo","year":"2021","journal-title":"Ophthalmology"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2023.2289","article-title":"Prevalence of diabetic retinopathy in the us in 2021","volume":"141","author":"Lundeen","year":"2023","journal-title":"JAMA Ophthalmol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"Cd013775","DOI":"10.1002\/14651858.CD013775.pub2","article-title":"Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy","volume":"2","author":"Perais","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.08.003","article-title":"Severity of diabetic retinopathy and health-related quality of life: the los angeles latino eye study","volume":"118","author":"Mazhar","year":"2011","journal-title":"Ophthalmology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-021-01572-4","article-title":"Recently updated global diabetic retinopathy screening guidelines: commonalities, differences, and future possibilities","volume":"35","author":"Das","year":"2021","journal-title":"Eye (Lond)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13265","article-title":"Combined effect of diabetic retinopathy and diabetic kidney disease on all-cause, cancer, vascular and non-cancer non-vascular mortality in patients with type 2 diabetes: A real-world longitudinal study","volume":"11","author":"Takao","year":"2020","journal-title":"J Diabetes Investig"},{"key":"B8","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1038\/s41572-022-00342-0","article-title":"Hypertensive eye disease","volume":"8","author":"Cheung","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"B9","doi-asserted-by":"publisher","first-page":"10458","DOI":"10.1038\/s41598-024-58502-z","article-title":"Association of diabetic retinopathy on all-cause and cause-specific mortality in older adults with diabetes: national health and nutrition examination survey, 2005-2008","volume":"14","author":"Liang","year":"2024","journal-title":"Sci Rep"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.750017","article-title":"Impact of retinopathy and systemic vascular comorbidities on all-cause mortality","volume":"12","author":"Zhu","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1186\/s12933-022-01675-6","article-title":"Synergistic effect of chronic kidney disease, neuropathy, and retinopathy on all-cause mortality in type 1 and type 2 diabetes: A 21-year longitudinal study","volume":"21","author":"Sacchetta","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2020.12.019","article-title":"Severity of diabetic retinopathy and the risk of future cerebrovascular disease, cardiovascular disease, and all-cause mortality","volume":"128","author":"Modjtahedi","year":"2021","journal-title":"Ophthalmology"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.6.1383","article-title":"Diabetic retinopathy is associated with mortality and cardiovascular disease incidence: the eurodiab prospective complications study","volume":"28","author":"van Hecke","year":"2005","journal-title":"Diabetes Care"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1443236","article-title":"Causal effect of immune cells, metabolites, cathepsins, and vitamin therapy in diabetic retinopathy: A mendelian randomization and cross-sectional study","volume":"15","author":"Zhou","year":"2024","journal-title":"Front Immunol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"11868","DOI":"10.1038\/s41598-024-62707-7","article-title":"Analysis of the association between high antioxidant diet and lifestyle habits and diabetic retinopathy based on nhanes cross-sectional study","volume":"14","author":"Qiao","year":"2024","journal-title":"Sci Rep"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-024-02328-8","article-title":"The differences of metabolic profiles, socioeconomic status and diabetic retinopathy in U.S. Working-age and elderly adults with diabetes: results from nhanes 1999-2018","volume":"62","author":"Li","year":"2024","journal-title":"Acta Diabetol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-17512-8","article-title":"Modifiable lifestyle, mental health status and diabetic retinopathy in U.S. Adults aged 18-64 years with diabetes: A population-based cross-sectional study from nhanes 1999-2018","volume":"24","author":"Li","year":"2024","journal-title":"BMC Public Health"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.966714","article-title":"Associations between psycho-behavioral risk factors and diabetic retinopathy: nhanes (2005-2018)","volume":"10","author":"Sun","year":"2022","journal-title":"Front Public Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1038\/s41598-024-51749-6","article-title":"Association between serum heavy metal levels and diabetic retinopathy in nhanes 2011-2020","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci Rep"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.111081","article-title":"Diabetic retinopathy related homeostatic dysregulation and its association with mortality among diabetes patients: A cohort study from nhanes","volume":"207","author":"Li","year":"2024","journal-title":"Diabetes Res Clin Pract"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1159\/000512667","article-title":"Diabetic retinopathy, visual impairment, and the risk of six-year death: A cohort study of a rural population in China","volume":"64","author":"Cao","year":"2021","journal-title":"Ophthalmic Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e0296019","DOI":"10.1371\/journal.pone.0296019","article-title":"Association between red blood cell distribution width\/albumin ratio and all-cause mortality or cardiovascular diseases mortality in patients with diabetic retinopathy: A cohort study","volume":"18","author":"Fu","year":"2023","journal-title":"PloS One"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2023.08.001","article-title":"Associations of cardiovascular health assessed by life\u2019s essential 8 with diabetic retinopathy and mortality in type 2 diabetes","volume":"17","author":"Shen","year":"2023","journal-title":"Prim Care Diabetes"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1266870","article-title":"Development and validation of a nomogram for predicting all-cause mortality in american adult hypertensive populations","volume":"14","author":"Yang","year":"2023","journal-title":"Front Pharmacol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1186\/s12877-022-03087-3","article-title":"Development, validation, and visualization of a web-based nomogram to predict 5-year mortality risk in older adults with hypertension","volume":"22","author":"Zhang","year":"2022","journal-title":"BMC Geriatr"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1177\/0272989x06295361","article-title":"Decision curve analysis: A novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Med Decis Making"},{"key":"B27","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s12916-019-1373-y","article-title":"The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large english primary care cohort","volume":"17","author":"Nowakowska","year":"2019","journal-title":"BMC Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab183","article-title":"All-cause mortality, cardiovascular mortality, major cardiovascular events and hypoglycaemia of patients with diabetes onset at an older age: results from the 10-year nationwide cohort study","volume":"50","author":"Chou","year":"2021","journal-title":"Age Ageing"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afs002","article-title":"Chronic kidney disease and mortality risk among older patients with type 2 diabetes mellitus (Zodiac-24)","volume":"41","author":"Drion","year":"2012","journal-title":"Age Ageing"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-023-02199-5","article-title":"Retinal age gap as a predictive biomarker for future risk of clinically significant diabetic retinopathy","volume":"61","author":"Chen","year":"2024","journal-title":"Acta Diabetol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.2147\/cia.S297494","article-title":"Diabetic retinopathy in the aging population: A perspective of pathogenesis and treatment","volume":"16","author":"Leley","year":"2021","journal-title":"Clin Interv Aging"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107804","article-title":"The association between polypharmacy and adverse health consequences in elderly type 2 diabetes mellitus patients; a systematic review and meta-analysis","volume":"155","author":"Al-Musawe","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.2337\/ds20-0018","article-title":"Challenges and strategies for managing diabetes in the elderly in long-term care settings","volume":"33","author":"Pandya","year":"2020","journal-title":"Diabetes Spectr"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-019-1061-4","article-title":"The impact of comorbidities on the pharmacological management of type 2 diabetes mellitus","volume":"79","author":"Hussain","year":"2019","journal-title":"Drugs"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.endinu.2017.10.006","article-title":"The effect of marital status on social and gender inequalities in diabetes mortality in andalusia","volume":"65","author":"Escolar-Pujolar","year":"2018","journal-title":"Endocrinol Diabetes Nutr (Engl Ed)"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.2147\/ijgm.S307436","article-title":"Diabetes mellitus and marital status: evidence from the national longitudinal mortality study on the effect of marital dissolution and the death of a spouse","volume":"14","author":"Kposowa","year":"2021","journal-title":"Int J Gen Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s12160-008-9018-y","article-title":"Is there something unique about marriage? The relative impact of marital status, relationship quality, and network social support on ambulatory blood pressure and mental health","volume":"35","author":"Holt-Lunstad","year":"2008","journal-title":"Ann Behav Med"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1177\/0145721707299265","article-title":"Social support and mortality among older persons with diabetes","volume":"33","author":"Zhang","year":"2007","journal-title":"Diabetes Educ"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3477","article-title":"Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care","volume":"354","author":"Hippisley-Cox","year":"2016","journal-title":"Bmj"},{"key":"B40","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12933-023-01821-8","article-title":"Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: A nationwide population-based cohort study","volume":"22","author":"Yen","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12933-024-02162-w","article-title":"The association between the aip and undiagnosed diabetes in acs patients with different body mass indexes and ldl-C levels: findings from the ccc-acs project","volume":"23","author":"Xu","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-1747","article-title":"Retinopathy predicts cardiovascular mortality in type 2 diabetic men and women","volume":"30","author":"Juutilainen","year":"2007","journal-title":"Diabetes Care"},{"key":"B43","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1186\/s12933-023-01965-7","article-title":"The role of oxidative stress in diabetes mellitus-induced vascular endothelial dysfunction","volume":"22","author":"An","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1186\/s12933-023-01979-1","article-title":"Inflammation and oxidative stress markers in type 2 diabetes patients with advanced carotid atherosclerosis","volume":"22","author":"M\u00e9n\u00e9gaut","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.02.045","article-title":"Mortality in older persons with retinopathy and concomitant health conditions: the age, gene\/environment susceptibility-reykjavik study","volume":"123","author":"Fisher","year":"2016","journal-title":"Ophthalmology"},{"key":"B46","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12955-023-02090-5","article-title":"Factors affecting the quality of life after ischemic stroke in young adults: A scoping review","volume":"21","author":"Gurkov\u00e1","year":"2023","journal-title":"Health Qual Life Outcomes"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1007\/s12291-010-0080-4","article-title":"Underestimation of impaired kidney function with serum creatinine","volume":"25","author":"Kannapiran","year":"2010","journal-title":"Indian J Clin Biochem"},{"key":"B48","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1053\/j.ajkd.2021.11.011","article-title":"Nonalbuminuric diabetic kidney disease and risk of all-cause mortality and cardiovascular and kidney outcomes in type 2 diabetes: findings from the hong kong diabetes biobank","volume":"80","author":"Jin","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"B49","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1053\/j.ajkd.2021.09.018","article-title":"Associations of plasma biomarkers of inflammation, fibrosis, and kidney tubular injury with progression of diabetic kidney disease: A cohort study","volume":"79","author":"Guti\u00e9rrez","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"B50","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1186\/s12902-022-01236-8","article-title":"Associations between diabetic retinopathy, mortality, disease, and mental health: an umbrella review of observational meta-analyses","volume":"22","author":"Trott","year":"2022","journal-title":"BMC Endocr Disord"},{"key":"B51","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12933-023-01937-x","article-title":"The cardio-renal-metabolic connection: A review of the evidence","volume":"22","author":"Marassi","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2005.06.014","article-title":"Associations of metabolic syndrome with inflammation in ckd: results from the third national health and nutrition examination survey (Nhanes iii)","volume":"46","author":"Beddhu","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.00188.2022","article-title":"Endothelial glycocalyx in retina, hyperglycemia, and diabetic retinopathy","volume":"324","author":"Kaur","year":"2023","journal-title":"Am J Physiol Cell Physiol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-3184","article-title":"Mortality in individuals treated with glucose-lowering agents: A large, controlled cohort study","volume":"101","author":"Claesen","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-157-9-201211060-00003","article-title":"Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: A cohort study","volume":"157","author":"Roumie","year":"2012","journal-title":"Ann Intern Med"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-3042","article-title":"Mortality and other important diabetes-related outcomes with insulin vs other antihyperglycemic therapies in type 2 diabetes","volume":"98","author":"Currie","year":"2013","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1493984\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T05:19:13Z","timestamp":1740115153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1493984\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,21]]},"references-count":56,"alternative-id":["10.3389\/fendo.2025.1493984"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1493984","relation":{},"ISSN":["1664-2392"],"issn-type":[{"type":"electronic","value":"1664-2392"}],"subject":[],"published":{"date-parts":[[2025,2,21]]},"article-number":"1493984"}}