Prediction value of plasma arteriosclerosis index and insulin resistance index in combination in decreased estimated glomerular filtration rate in patients with type 2 diabetes mellitus

Objective To investigate the combined prediction value of plasma arteriosclerosis index (AIP) and insulin resistance index (HOMA-IR) in the reduction of estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus (T2DM).

Methods The clinical data and biochemical indexes of 125 patients with T2DM were collected, such as age, disease course, diastolic blood pressure (DBP), systolic blood pressure (SBP), fasting blood glucose (FBS), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), very low density lipoprotein cholesterol(VLDL-C), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), eGFR, cystatin C (CysC), lipoprotein a Lp(a), creatinine (Cr), uric acid (UA), 24-hour urinary protein, and AIP and HOMA-IR were calculated. According to the eGFR level, the patients were divided into T2DM group 76 cases, eGFR≥90 mL/(min·1.73 m²) and eGFR reduced group 49 cases, eGFR < 90 mL/(min·1.73 m²). The clinical data, biochemical indexes, HOMA-IR and AIP between the two groups were compared. The relationships of AIP and HOMA-IR with the decrease of eGFR in T2DM patients were analyzed by binary Logistic regression, and the combined prediction model was constructed. Receiver operating characteristic (ROC) curve was drawn to analyze the value of HOMA-IR or AIP alone and their combination in predicting eGFR reduction in T2DM patients.

Results There were significant differences in AIP, HOMA-IR, age, course of disease, DBP, FINS, TG, CysC, Lp(a), Cr, UA and 24 h urinary protein between the two groups (P < 0.05). Increased levels of AIP and HOMA-IR were independent risk factors for decreased eGFR in T2DM patients(P < 0.05), and the joint predictor of both was Logit(P)=-1.764+0.765×AIP+0.157×HOMA-IR. ROC curve analysis results showed that the areas under the curve (AUC) of AIP alone and HOMA-IR alone were 0.605 (95%CI, 0.501 to 0.709) and 0.707 (95%CI, 0.600 to 0.810), respectively. The cut-off values were 0.48 and 0.32, and the sensitivities were 27% and 66%, and the specificities were 96% and 76%, respectively. The AUC of their combined prediction was 0.710 (95%CI, 0.600 to 0.820), the cut-off value was 0.31, the sensitivity was 66%, and the specificity was 73%.

Conclusion AIP and HOMA-IR are independent risk factors for eGFR reduction in T2DM patients, and the value of eGFR reduction predicted by both AIP and HOMA-IR is higher than that predicted separately.