Circulating AFABP, FGF21, and PEDF Levels as Prognostic Biomarkers of Sight-threatening Diabetic Retinopathy

Abstract

Background Adipocyte fatty acid-binding protein (AFABP), fibroblast growth factor 21 (FGF21) and pigment epithelium-derived factor (PEDF) are three diabetes-related biomarkers whose circulating levels had been shown to associate with nephropathy progression in Chinese patients with type 2 diabetes. Here, we evaluated and compared their prospective associations with the development of sight-threatening diabetic retinopathy (STDR), another important diabetic micro-vascular complication. Methods Baseline serum AFABP, PEDF and FGF21 levels were measured in 4760 Chinese individuals with type 2 diabetes and without STDR at baseline. The associations of these biomarkers with incident STDR were analyzed using Cox regression analysis. Results Among these 4760 participants (mean diabetes duration of 11 years and ≥50% with non-proliferative diabetic retinopathy at baseline), 172 participants developed STDR over a median follow-up of 8.8 years. Participants with incident STDR had comparable baseline serum FGF21 levels but significantly higher baseline serum AFABP and PEDF levels (both p<0.001) than those without. However, in multivariable Cox regression analysis, only serum AFABP remained independently associated with incident STDR (HR 1.28, 95%CI 1.05–1.55, p=0.013). The addition of serum AFABP to a clinical model of conventional STDR risk factors including diabetes duration, glycemic control, albuminuria and baseline diabetic retinopathy status significantly improved the c-statistics (p<0.001), net reclassification index (p=0.0027) and integrated discrimination index (p=0.033) in predicting incident STDR among participants without DR or with mild DR at baseline. Conclusion Among the three diabetes-related biomarkers, serum AFABP level appeared to be a more clinically useful biomarker for predicting incident STDR in type 2 diabetes.

Association between neutrophil-to-lymphocyte ratio and diabetic retinopathy in patients with type 2 diabetes: a cohort study

“…Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg or antihypertensive medication use ( 15 ). Dyslipidemia was defined as fasting triglycerides (TG) ≥1.7 mmol/L, high-density lipoprotein cholesterol (HDL-c) ≤1.04 mmol/L (males) or ≤1.30 mmol/L (females), and low-density lipoprotein cholesterol (LDL-c) ≥ 2.60 mmol/L determined by enzymatic assays (AU5800, Beckman Coulter, USA) or on lipid-lowering agents ( 16 ).…”