{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T10:39:44Z","timestamp":1773916784849,"version":"3.50.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"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>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u00a0&amp;lt;\u00a00.001) and lower IBIL levels (6.90 \u00b1 3.89 vs. 9.72 \u00b1 4.98 \u03bcmol\/L, P\u00a0&amp;lt;\u00a00.001). Multivariable analysis confirmed cystatin C (OR\u00a0=\u00a01.342 per 0.1 mg\/L increase, 95% CI 1.111-1.621, P\u00a0=\u00a00.002) and IBIL (OR\u00a0=\u00a01.139 per \u03bcmol\/L decrease, 95% CI 1.031-1.259, P\u00a0=\u00a00.011) as independent STDR predictors. The highest cystatin C tertile had 7.576-fold increased STDR odds (95% CI 2.560-22.419, P\u00a0&amp;lt;\u00a00.001). ROC analysis showed cystatin C (&amp;gt;1.025 mg\/L) predicted STDR with area under the receiver operating characteristic curve (AUROC)=0.737, while IBIL (&amp;lt;6.09 \u03bcmol\/L) had AUROC\u00a0=\u00a00.667. Combination strategies provided flexible performance: \u201cOR\u201d rule (either high cystatin C or low IBIL) achieved 80.6% sensitivity, while \u201cAND\u201d rule (both high cystatin C and low IBIL) reached 94.9% specificity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Serum cystatin C and IBIL are independent predictors of STDR in T2DM. Their combination offers a flexible screening approach\u2014achieving either high sensitivity or high specificity\u2014providing a practical tool for risk stratification and early detection of STDR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1751821","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:23:17Z","timestamp":1773897797000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting sight-threatening diabetic retinopathy using the combination of serum cystatin C and indirect bilirubin"],"prefix":"10.3389","volume":"17","author":[{"given":"Yujie","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, China-Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lulu","family":"Song","sequence":"additional","affiliation":[{"name":"Department of 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