Diagnostic value of urinary albumin creatinine ratio in predicting vision-threatening diabetic retinopathy in patients with diabetes: a systematic review and Meta-analysis

To evaluate the predictive value of urinary albumin creatinine ratio (UACR), albumin excretion rate (AER), and estimated glomerular filtration rate (eGFR) for vision-threatening diabetic retinopathy (VTDR) in individuals with diabetes.

A comprehensive literature search across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library from their inception to February 2024 were performed. The diagnostic accuracy of microalbuminuria (MA; including UACR and AER) and eGFR in predicting VTDR using sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (ROC) curve were assessed. Analyses incorporated both bivariate generalized linear mixed models and random-effects models to ensure a robust and unbiased interpretation of the data.

The review included 14 studies with a total of 87223 patients. The pooled sensitivity and specificity of MA and eGFR for predicting VTDR were 0.77 [95% confidence interval (CI), 0.57–0.89] and 0.51 (95%CI, 0.31–0.72), respectively. The DOR was 3.47 (95%CI, 1.94–6.18), with the area under the summary ROC curve at 0.70 (95%CI, 0.66–0.74). Notably, UACR as a predictor showed a sensitivity of 0.88 (95%CI, 0.43–0.99) and specificity of 0.55 (95%CI, 0.22–0.84), with an area under the curve of 0.78 (95%CI, 0.74–0.82). Despite significant heterogeneity among the studies (P<0.01), no publication bias was detected.

UACR is a highly sensitive but moderately specific indicator for early detection and management strategies in this high-risk population.