A hematologic composite score integrating iron, coagulation, and inflammation markers predicts diabetic retinopathy severity: a retrospective cross-sectional study.

Abstract

Objectives: This study aimed to develop and validate a hematological composite score incorporating ferritin, transferrin, fibrinogen, and the neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) to predict diabetic retinopathy (DR) severity.

Methods: In this single-center retrospective cross-sectional study, 356 patients with type 2 diabetes were categorized into non-DR (n=142), non-proliferative DR (NPDR, n=112), and proliferative DR (PDR, n=102). The composite score was calculated as: (Ferritin × Fibrinogen × NLR × PLR)/Transferrin. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were conducted to evaluate predictive performance, adjusting for relevant covariates.

Results: The composite score showed strong discriminatory ability for identifying PDR (AUC=0.898; 95% CI: 0.85-0.93), significantly outperforming individual markers (e.g., ferritin AUC=0.744, fibrinogen AUC=0.722; P<0.001). Each standard deviation increase in the score was associated with a 2.8-fold higher odds of PDR (adjusted OR=2.83; 95% CI: 2.12-3.78). Subgroup analysis revealed greater predictive accuracy in patients with diabetes duration ≥10 years (AUC=0.92) compared to those with <10 years (AUC=0.82; P for interaction =0.012).

Conclusions: This hematologic composite score, integrating iron, coagulation, and inflammation markers, offers a cost-effective and clinically accessible tool for DR severity assessment, particularly in patients with long-standing diabetes. Its implementation may enhance screening precision and inform individualized management strategies.