Medical Journal of Malaysia最新文献

{"title":"Prevalence and determinants of antimicrobial resistance in pneumonia among adult patients in Hospital Shah Alam, Malaysia.","authors":"A Z Z Zulkifli, F M N Ghazali, R A Md Salleh, M T Suryani, S M Yasin, M R Isa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Antimicrobial resistance (AMR) continues to threaten our healthcare system. Unnecessary antibiotic use contributes to the development of AMR infections in hospitalized pneumonia patients. This study was conducted to determine the prevalence of AMR and its associated factors in pneumonia among adult patients treated in-patient in a hospital.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted using data extracted from the hospital's electronic medical records. Patients aged 18 years or older admitted to the hospital from 1st January 2018 to 31st December 31 2023, discharged with a diagnosis of pneumonia were included in the study population.</p><p><strong>Results: </strong>A total of 300 eligible samples were selected using universal sampling. The analysis revealed a prevalence of AMR of 15.7% (95% CI: 11.5, 19.8). Multivariable analysis using multiple logistic regression showed that patients' age (OR = 1.03; 95% CI: 1.01, 1.05), Indian and other ethnicities (OR = 2.24; 95% CI: 1.05, 4.77), length of stay (OR = 1.05; 95% CI: 1.01, 1.08) and invasive procedures (OR = 3.65; 95% CI: 1.71, 7.82) were significantly associated with AMR.</p><p><strong>Conclusion: </strong>The findings from our study highlighted a considerable burden of AMR among pneumonia patients in a Malaysian tertiary hospital. Thus, there is a need for targeted infection control strategies and antimicrobial stewardship, especially among high-risk groups. Strengthening surveillance and justified antibiotic use is crucial to fight the rising threat of AMR in Malaysia.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"692-698"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of patients' participation in cardiac rehabilitation programs: A scoping review.","authors":"D C Chin, F M Said, R Kumilau, H B Liew, S Saharudin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac rehabilitation (CR) has been shown to reduce morbidity and mortality while enhancing quality of life in patients with cardiovascular disease. Despite these benefits, participation in CR programs remains low globally. This scoping review aimed to map the determinants influencing patients' participation in CR.</p><p><strong>Materials and methods: </strong>A systematic search of peerreviewed publications from 2016 to 2023 was performed. Studies were included if they examined patient-level or system-level determinants affecting participation in Phase II CR. Data was systematically extracted, and the Critical Appraisal Skills Programme checklist was used to assess methodological quality. The findings were integrated and interpreted using thematic analysis and reported in accordance with PRISMA-ScR guidelines.</p><p><strong>Results: </strong>Ten studies from diverse countries, predominantly cross-sectional, were selected for review. Structural and logistical barriers were most prominent, including transportation issues, distance, inconvenient locations, time constraints, and financial costs. Sociodemographic factors such as older age, lower education, reduced income, unemployment, immigrant status, and family responsibilities were linked to lower participation. Psychosocial barriers included anxiety, limited social support, and preference for self-management. Healthcare system barriers involved lack of referrals, limited physician encouragement, and poor dissemination of information. Knowledge and perceived need barriers were evident, with low awareness, limited understanding of benefits, perceived lack of necessity, and concerns about fatigue, comorbidities, and exercise tolerance. Overall, participation is shaped by complex, interrelated structural, individual, and system-level factors.</p><p><strong>Conclusion: </strong>Engagement in CR is shaped by a complex interaction of structural, individual, and healthcare system factors. Approaches such as home-based and hybrid CR models, improved referral pathways, and targeted patient education may enhance participation and support better clinical outcomes.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"778-786"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis treatment success and its determinants among healthcare workers with tuberculosis in Selangor: A retrospective cross-sectional study.","authors":"N F Mustapha, K Muzaini, S S Yaacob, S H Ilias, A R Edwin, M Mohamad","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Tuberculosis (TB) remains a major occupational risk for healthcare workers (HCWs), who face higher exposure and potential challenges in achieving optimal treatment outcomes. Despite extensive national TB control strategies in Malaysia, evidence on treatment success and its determinants among HCWs is limited. This study aimed to determine the proportion of TB treatment success and identify associated factors among HCWs with active TB in Selangor from 2014 to 2023 using the National Tuberculosis Registry (NTBR) system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A retrospective cross-sectional study was conducted using registry data from NTBR involving all HCWs diagnosed with active TB and registered in Selangor between 2014 and 2023. Universal sampling was applied to include all eligible cases with complete data. Variables were extracted across sociodemographic, occupational, sociocultural, and clinical domains. TB treatment success was defined as \"cured\" or \"treatment completed\", while unsuccessful outcomes included death, treatment failure, and not evaluated. Data were cleaned, deidentified, and analysed using SPSS version 29. Simple logistic regression identified variables with p&lt;0.25 for inclusion in multiple logistic regression Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported. Model diagnostics included the Hosmer- Lemeshow test, ROC (Receiver Operating Characteristic) analysis, multicollinearity checks, interaction terms, and Cook's distance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 313 HCWs with active TB were included. The TB treatment success rate was 86.9%, with 51.5% cured and 48.5% completing treatment. In multivariable analysis, three factors remained significantly associated with treatment success. HCWs aged &lt;34 years had higher odds of treatment success (AOR=5.071; 95% CI: 2.009-12.801). Conversely, doctors (AOR=0.024; 95% CI: 0.003-0.218) and supporting staff (AOR=0.366; 95% CI: 0.143-0.936) showed significantly lower success compared to paramedics. Advanced chest X-ray (CXR) findings demonstrated strong positive associations: moderate (AOR=14.686; 95% CI: 5.873 - 36.724) and far advanced disease (AOR=10.783; 95% CI: 1.909-60.904). Commonly reported risk factors such as HIV, diabetes, smoking, BCG (Bacillus Calmette-Guérin) status, and comorbidities were not significantly associated. Model performance was robust (ROC: 88.3%; Hosmer-Lemeshow p=0.858).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;TB treatment is successful among HCWs in Selangor (86.9%), which is near to the WHO (World Health Organization) End TB Strategy. The odds of treatment success were much higher among younger HCWs, whereas doctors and other supporting staff reported had lower adjusted odds in comparison with paramedics. Moderate and far advanced CXR findings at diagnosis were independently associated with higher treatment success; however, this finding should be interpreted cautiously because of the small n","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"699-706"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Handheld echocardiography for rural cardiac triage in primary care: A feasibility and diagnostic agreement study of a task-shifting model with remote cardiologist validation.","authors":"E Z Chan, A S C Chai, H S Ling, H B Chow, W K Ho, A Said, Y L Cham, A Y Y Fong, T K Ong, B K Chung","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Access to formal echocardiography is often delayed in geographically remote settings. This study evaluated the feasibility, image quality and diagnostic agreement of focused handheld echocardiography performed by a trained Family Medicine Specialist (FMS) in a rural Malaysian clinic with asynchronous cardiologist validation.</p><p><strong>Materials and methods: </strong>We conducted a retrospective observational study of 41 adult patients who underwent focused handheld echocardiography for dyspnoea or suspected cardiac symptoms at a rural primary care clinic in Sarawak, Malaysia, between 24 August 2025 and 5 February 2026. A trained FMS performed focused examinations during routine care. Stored images were reviewed asynchronously by a consultant cardiologist blinded to the FMS interpretation. We evaluated workflow feasibility, cardiologist-rated image quality and agreement for classification of left ventricular (LV) systolic function as normal or reduced.</p><p><strong>Results: </strong>Forty-one patients were included (mean age 60.4±17.5 years; 51% male). Median scan duration was 8 minutes (range 3-14), and technical difficulties were reported in 19 examinations (46.3%). Nevertheless, all 41 stored studies contained sufficient images for cardiologist classification of LV systolic function. Endocardial border definition was rated good or fair in 87.8% of studies, whereas colour Doppler was frequently non-diagnostic. The FMS identified reduced LV systolic function in 13 patients (32%), compared with 10 patients (24%) by cardiologist review. Overall agreement was 82.9%, with Cohen's kappa 0.58. Sensitivity was 80.0%, specificity 83.9%, positive predictive value 61.5%, negative predictive value 92.9% and overall accuracy 82.9%.</p><p><strong>Conclusion: </strong>In this rural primary care setting, focused handheld echocardiography performed by a trained FMS was feasible and showed moderate agreement with remote cardiologist interpretation for identifying reduced left ventricular systolic function. These findings support a hypothesis-generating service-delivery model in which handheld ultrasound may assist rural cardiac triage and referral prioritization, but larger multi-site studies are needed before practice-changing implementation can be recommended.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"735-739"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) and thrombotic or ischemic cardiovascular and cardiopulmonary diseases: A systematic review.","authors":"M A G Siregar, H Ali, R Rahmadian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) is a platelet- and endotheliumassociated glycoprotein implicated in platelet activation, thrombus propagation, and endothelial injury. Because these processes underpin thrombo-inflammatory cardiovascular and cardiopulmonary diseases, circulating SCUBE1 has attracted interest as a candidate biomarker. This systematic review aimed to critically synthesize comparative clinical evidence on circulating SCUBE1 levels across thrombotic or ischemic cardiovascular and cardiopulmonary conditions relative to control or comparator groups.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, ScienceDirect, and SpringerLink was conducted for Englishlanguage studies published from 1 January 2015 to 27 September 2025. The protocol was prospectively registered in PROSPERO (CRD420251178563). Eligibility was guided by a PECO framework and included observational and diagnostic accuracy studies that measured circulating SCUBE1 in serum or plasma and reported patientcomparator data. Two reviewers independently screened studies, extracted data, and assessed methodological quality using design-specific Joanna Briggs Institute tools and ROBINS-I. Owing to clinical and methodological heterogeneity, findings were synthesized narratively without meta-analysis.</p><p><strong>Results: </strong>Nine studies were included (four cross-sectional, three case-control, one cohort, and one diagnostic accuracy study). SCUBE1 levels were generally higher in patients with thrombotic or ischemic cardiovascular and cardiopulmonary diseases than in comparators, supporting associations with platelet-endothelial activation, thrombotic burden, endothelial dysfunction, and ischemia-reperfusion stress. However, absolute concentrations varied markedly across studies, precluding direct comparison and limiting interpretability of proposed cut-off values. Eight studies had moderate risk of bias and one had serious risk.</p><p><strong>Conclusion: </strong>SCUBE1 is a biologically plausible but still investigational biomarker; robust multicenter prospective studies with standardized assays are required before clinical translation in routine clinical practice.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"740-749"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of procalcitonin for identifying paediatric sepsis: A retrospective study in a Malaysian tertiary hospital.","authors":"S M A Razak, M N A Taib, K Abdul Jalil, R Arifin, N S Nik Wan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Early diagnosis of paediatric sepsis remains challenging because clinical manifestations are non-specific and microbiological culture results are often delayed. Procalcitonin (PCT) has emerged as a promising biomarker for bacterial infection; however, its diagnostic performance varies across patient populations and clinical settings. This study evaluated the diagnostic accuracy of serum PCT for identifying paediatric sepsis in a Malaysian tertiary referral hospital.</p><p><strong>Materials and methods: </strong>A retrospective descriptive study was conducted at Hospital Sultanah Nur Zahirah, Terengganu, Malaysia, between June 2022 and June 2024. Children aged 1 month to 18 years who underwent serum PCT testing for suspected infection were included. Paediatric sepsis was classified according to the 2005 International Paediatric Sepsis Consensus Conference criteria, supported by microbiologically confirmed infection or a Phoenix Sepsis Score ≥2 in culture-negative cases. Serum PCT, C-reactive protein (CRP), and total white cell count (TWC) obtained at initial presentation were analysed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, predictive values, likelihood ratios, and diagnostic odds ratio.</p><p><strong>Results: </strong>A total of 242 children were included, of whom 129 (53.3%) were classified as having sepsis. Median PCT concentrations were significantly higher in the sepsis group than in the non-sepsis group (1.940 vs. 0.240 ng/mL; p < 0.0001). At a cut-off value of 0.5 ng/mL, PCT demonstrated a sensitivity of 76.0%, specificity of 73.5%, positive predictive value of 76.6%, negative predictive value of 72.8%, positive likelihood ratio of 2.86, negative likelihood ratio of 0.33, and diagnostic odds ratio of 8.75. ROC analysis showed moderate diagnostic accuracy with an area under the curve of 0.747 (95% confidence interval: 0.692-0.802). PCT demonstrated a moderate positive correlation with CRP (Spearman's r = 0.546) but no significant correlation with TWC.</p><p><strong>Conclusion: </strong>Serum PCT demonstrated moderate diagnostic accuracy for identifying paediatric sepsis and may serve as a useful adjunctive biomarker for the early evaluation of children with suspected sepsis. However, PCT should be interpreted alongside clinical assessment and microbiological investigations rather than used as a standalone diagnostic test.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"707-713"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of quality of life among older adults with recurrent diabetic foot ulcers.","authors":"H Haryanto, P Ardhana, P A Wahab","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic foot ulcers (DFUs) are a serious complication of diabetes mellitus. DFUs have a profound impact on patients' health-related quality of life (HRQoL). This study aimed to evaluate age-related variations in HRQoL and to identify factors associated with physical and mental health among patients with recurrent DFUs.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted among 245 patients with type 2 diabetes mellitus. HRQoL was measured using the Indonesian version of the SF-36, whereas depression, diabetes distress, and self-care adherence were evaluated using the Beck Depression Inventory II (BDI-II), the Diabetes Distress Scale-17 (DDS-17), and the Summary of Diabetes Self-Care Activities (SDSCA), respectively. Data were analysed using bivariate tests and multivariate linear regression.</p><p><strong>Results: </strong>Older adults (≥60 years) had significantly lower physical functioning and general health scores (p < 0.05). Depression (β = -0.48, p < 0.001) and diabetes distress (β = -0.25, p = 0.003) were independent predictors of poorer physical HRQoL, whereas higher self-care adherence improved HRQoL (β = 0.18, p = 0.014). Age was not a significant factor after adjustment. Physical HRQoL is poorer among older adults with recurrent DFUs, primarily mediated by psychosocial distress.</p><p><strong>Conclusion: </strong>Our findings demonstrated that psychosocial conditions, especially depression and diabetes-related distress, significantly contribute to poor HRQoL. There is a relationship between depression, distress, and poor quality of life. Moreover, depression and distress independently predicted lower physical QoL, and better self-care is a predictor of QoL. Integrated management addressing psychological well-being and self-care behaviours may enhance the overall patient outcomes.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"661-668"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associated factors of single pill combination therapy among people with hypertension in a tertiary hospital.","authors":"N K Devaraj, T Chandrabose, V Manimaran, M I Nor Azwadi, N A A Ahmad Fadzlee, T R Tajudin, Z A Parpia","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Effective management of hypertension often requires pharmacological intervention, which can involve either single pill combination therapy (SPC) or multiple pill combination therapy (MPC). However, the choice between SPC and MPC can be influenced by patient demographics, clinical characteristics, comorbid conditions and physician preferences. This study was aimed at exploring the prevalence of SPC versus MPC usage among people with hypertension in a tertiary hospital and its associated factors.</p><p><strong>Materials and methods: </strong>A cross-sectional study using a validated questionnaire was conducted among the hypertensive patients aged 18 years and on antihypertensive medication(s) for at least six months attending various speciality clinics at Hospital Sultan Abdul Aziz Shah, Selangor.</p><p><strong>Results: </strong>The prevalence of patients using SPC was 27.9% (78/280). In univariate analysis, factors that were found to be associated with the use of SPC were presence of diabetes mellitus (p < 0.001), presence of chronic kidney disease (p = 0.033), physician's own preference for SPC (p = 0.027) and duration of hypertension (p = 0.003). The independent factors associated with SPC use was the presence of chronic kidney disease, physician's own preference for SPC and absence of diabetes mellitus (p < 0.05).</p><p><strong>Conclusion: </strong>The use of SPC is only 27.9%. The independent factors associated with SPC use was the presence of chronic kidney disease, physician's own preference for SPC and absence of diabetes mellitus. Hence, this study's findings can be applied by healthcare providers who should consider these factors when prescribing hypertension treatments. Tailoring the treatment plan to the individual patient's needs and circumstances can enhance adherence and efficacy.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"677-684"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain health is heart health.","authors":"B S Liew","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"623-626"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence driven prognostic models for predicting diabetic retinopathy risk in type 2 diabetes mellitus: A systematic review.","authors":"M M S Teruna, T R Razak, S M Yasin, A A R Ali, M M M Salleh, M Z M Yusoff, M H A Khebir, N A C Rameli, M I M Sallehhudin, M S M Asraff, M R Isa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic retinopathy remains a leading cause of preventable blindness among individuals with type 2 diabetes mellitus and is driven by the increasing global burden of diabetes. Early identification of individuals at high risk is essential for timely intervention. In recent years, artificial intelligence, including machine learning and deep learning, has emerged as a promising approach for prognostic modelling. However, evidence on artificial intelligence-driven models for predicting diabetic retinopathy risk remains fragmented. This systematic review aims to synthesise current evidence on artificial intelligence-driven prognostic models for predicting the risk of diabetic retinopathy among individuals with type 2 diabetes mellitus, focusing on model characteristics, predictor variables, performance, and validation strategies.</p><p><strong>Materials and methods: </strong>A comprehensive search of PubMed, Scopus, Web of Science, and ScienceDirect was performed for studies published between January 2016 and December 2025. Eligible studies included those applying artificial intelligence-based models for diabetic retinopathy risk prediction in adult populations with type 2 diabetes mellitus and reporting model performance metrics. Data were extracted and synthesised narratively, and methodological quality was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>A total of 1040 records were identified, with eight studies included after screening. A wide range of artificial intelligence algorithms was applied, with ensemble models such as extreme gradient boosting and random forest demonstrating superior performance. Key predictors consistently included glycated haemoglobin levels, duration of diabetes, blood pressure, lipid profile, and renal function markers, alongside emerging metabolomic biomarkers. Model performance ranged from moderate to excellent, with area under the receiver operating characteristic curve values between 0.68 and 0.97. Most studies employed internal validation techniques such as cross-validation or training and testing data splits, while external validation was largely absent. Overall methodological quality was high, although variability in study design, predictor selection, and reporting was observed.</p><p><strong>Conclusion: </strong>Artificial intelligence-driven prognostic models show substantial potential in predicting diabetic retinopathy risk among individuals with type 2 diabetes mellitus, particularly through the integration of clinical and highdimensional data. Despite promising predictive performance, limitations in external validation, heterogeneity, and reporting of clinical utility hinder translation into practice. Future research should prioritise external validation, standardised reporting frameworks, and clinically interpretable models to enhance applicability in real-world healthcare settings.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"759-768"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}