Cron D C, Friedman J F, Winder G S, Thelen A E, Derck J E, Fakhoury J W, Gerebics A D, Englesbe M J, Sonnenday C J
Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI.
Am J Transplant. 2016 Jun;16(6):1805-11. doi: 10.1111/ajt.13639. Epub 2016 Feb 24.
End-stage liver disease (ESLD) patients are believed to have a high prevalence of depression, although mental health in ESLD has not been studied comprehensively. Further, the relationship between depression and severity of liver disease is unclear. Using baseline data from a large prospective cohort study (N = 500) of frailty in ESLD patients, we studied the association of frailty with depression. Frailty was assessed with the five-component Fried Frailty Index. Patients were assigned a composite score of 0 to 5, with scores ≥3 considered frail. Depression was assessed using the 15-question Geriatric Depression Scale, with a threshold of ≥6 indicating depression; 43.2% of patients were frail and 39.4% of patients were depressed (median score 4, range 0-15). In multivariate analysis, frailty was significantly associated with depression (odds ratio 2.78, 95% confidence interval 1.87-4.15, p < 0.001), whereas model for ESLD score was not associated with depression. After covariate adjustment, depression prevalence was 3.6 times higher in the most-frail patients than the least-frail patients. In conclusion, depression is common in ESLD patients and is strongly associated with frailty but not with severity of liver disease. Transplant centers should address mental health issues and frailty; targeted interventions may lower the burden of mental illness in this population.
尽管尚未对终末期肝病（ESLD）患者的心理健康进行全面研究，但人们认为该群体中抑郁症的患病率很高。此外，抑郁症与肝病严重程度之间的关系尚不清楚。我们利用一项针对ESLD患者虚弱状况的大型前瞻性队列研究（N = 500）的基线数据，研究了虚弱与抑郁症之间的关联。采用五成分Fried虚弱指数评估虚弱状况。患者被赋予0至5的综合评分，评分≥3被视为虚弱。使用15题老年抑郁量表评估抑郁症，阈值≥6表明患有抑郁症；43.2%的患者虚弱，39.4%的患者患有抑郁症（中位数评分4，范围0 - 15）。在多变量分析中，虚弱与抑郁症显著相关（优势比2.78，95%置信区间1.87 - 4.15，p < 0.001），而ESLD评分模型与抑郁症无关。在进行协变量调整后，最虚弱患者的抑郁症患病率比最不虚弱患者高3.6倍。总之，抑郁症在ESLD患者中很常见，且与虚弱密切相关，但与肝病严重程度无关。移植中心应关注心理健康问题和虚弱状况；有针对性的干预措施可能会减轻该人群的精神疾病负担。
