From biomarkers to better outcomes: Patient empowerment through accessible urine-based mortality risk tools—a systematic review

Background: Biomarkers measured in urine have emerged as valuable tools for assessing overall health status and predicting long-term outcomes, including all-cause mortality, even among individuals without apparent disease. Unlike biomarkers that focus on single disease endpoints, those associated with all-cause mortality provide a holistic health measure, capturing both direct and indirect effects of interventions. Regular self-monitoring of such biomarkers may empower patients and clinicians to implement timely preventive strategies and improve health outcomes. Objective: To systematically review and synthesize the current evidence on urinary biomarkers associated with all-cause mortality, with the goal of identifying markers that are predictive, modifiable, and practical for integration into preventive healthcare and patient self-management. Methods: A literature-based review was conducted, focusing exclusively on urinary biomarkers that have demonstrated statistically significant associations ( P ≤ 0.05) with all-cause mortality in at least one peer-reviewed study. Only studies reporting associations with all-cause mortality were considered. The review also assessed the practicality, affordability, and potential cost-effectiveness of incorporating these biomarkers into routine care. Results: Several urinary biomarkers were identified as robust predictors of all-cause mortality. Conclusion: Urinary biomarkers provide a practical, cost-effective, and clinically meaningful means to identify individuals at increased risk of mortality, even among those considered healthy. Many of these markers are modifiable through established lifestyle and medical interventions, making them actionable targets for preventive care.