Abstract
Background: No specific and sufficient diagnostic biomarkers are currently available for predicting diabetic retinopathy (DR). Objectives: This study was conducted to investigate the validity of serum sorbitol and Vascular Endothelial Growth Factor A (VEGF-A) in diagnosing DR and differentiating it from diabetes without retinopathy (DNR). The study also investigated the diagnostic efficiency of these biomarkers when compared to optical coherence tomography OCT. Methods: A cross-sectional study included 164 diabetes mellitus patients: 30 patients with no retinopathy (the control group), 86 patients with non-proliferative diabetic retinopathy (NPDR), and 48 patients with Proliferative Diabetic Retinopathy (PDR). Patients were referred to the Layla Qasim Diabetic Center between November 2016 and October 2017 and an ophthalmologist established a DR diagnosis using OCT. Serum sorbitol and serum VEGF-A were measured for all patients. Results: By using study biomarkers, the cut-off values of VEGF-A (124.7 ng/ml) and sorbitol (0.3112 mg/ml) were established, and their validity parameters. For sorbitol, the values were as follows: specificity was 75.4, the sensitivity was 80 and 68.3% of observed agreement with the results of the OCT technique. For VEGF-A, the specificity was 73.1 the sensitivity was 80 and 76.2% of the observed agreement. The combined parallel test was applied as negative if both the tests were negative or as positive if either of the tests was positive: a highly significant statistical agreement (Kappa test p <0.001) was found with the gold standard diagnosis (OCT), with 85.4% of observed agreement. Conclusion: A combination of serum sorbitol and VEGF-A for diagnosing DR and for differentiating DR from DNR patients exhibits a significant agreement with an OCT diagnosis.
Highlights
A combination of serum sorbitol and Vascular Endothelial Growth Factor A (VEGF-A) for diagnosing diabetic retinopathy (DR) and for differentiating DR from Diabetic NonRetinopathy (DNR) patients exhibits a significant agreement with an Optical Coherence Tomography (OCT) diagnosis
vascular endothelial growth factor (VEGF) is an encouraging factor that is studied in association with diabetic retinopathy; it induces angiogenesis, enhances endothelial cell development and neovascularization, and increments vascular porousness in the ischaemic retina [6, 7]
A high intraocular concentration of VEGF corresponds to increased vascular penetrability, which progresses to haemorrhage, exudates and vascular seepage, prompting nonproliferative diabetic retinopathy (NPDR)
Summary
Throughout diabetes, retinal pericytes collect AGEs, which detrimentally affect pericytes survival and task [1 - 5]. AGEs cause apoptosis of retinal pericytes and instigate vascular endothelial growth factor (VEGF). VEGF is an encouraging factor that is studied in association with diabetic retinopathy; it induces angiogenesis (which causes a breakdown of the bloodretinal barrier), enhances endothelial cell development and neovascularization (production of new blood vessels), and increments vascular porousness in the ischaemic retina [6, 7]. A high intraocular concentration of VEGF corresponds to increased vascular penetrability, which progresses to haemorrhage, exudates and vascular seepage, prompting nonproliferative diabetic retinopathy (NPDR). No specific and sufficient diagnostic biomarkers are currently available for predicting diabetic retinopathy (DR)
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