Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Transpl Int. 2018 May;31(5):495-502. doi: 10.1111/tri.13094. Epub 2017 Dec 14.
Depressive symptoms are common among lung transplant candidates and have been associated with poorer clinical outcomes in some studies. Previous studies have been plagued by methodologic problems, including small sample sizes, few clinical events, and uncontrolled confounders, particularly perioperative complications. In addition, few studies have examined social support as a potential protective factor. We therefore examined the association between pretransplant depressive symptoms, social support, and mortality in a large sample of lung transplant recipients. As a secondary aim, we also examined the associations between psychosocial factors, perioperative outcomes [indexed by hospital length of stay (LOS)], and mortality. We hypothesized that depression would be associated with longer LOS and that the association between depression, social support, and mortality would be moderated by LOS. Participants included lung transplant recipients, transplanted at Duke University Medical Center from January 2009 to December 2014. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI-II) and social support using the Perceived Social Support Scale (PSSS). Medical risk factors included forced vital capacity (FVC), partial pressure of carbon dioxide (PCO ), donor age, acute rejection, and transplant type. Functional status was assessed using six-minute walk distance (6MWD). We also controlled for demographic factors, including age, gender, and native disease. Transplant hospitalization LOS was examined as a marker of perioperative clinical outcomes. Participants included 273 lung recipients (174 restrictive, 67 obstructive, 26 cystic fibrosis, and six "other"). Pretransplant depressive symptoms were common, with 56 participants (21%) exhibiting clinically elevated levels (BDI-II ≥ 14). Greater depressive symptoms were associated with longer LOS [adjusted b = 0.20 (2 days per 7-point higher BDI-II score), P < 0.01]. LOS moderated the associations between depressive symptoms (P = 0.019), social support (P < 0.001), and mortality, such that greater depressive symptoms and lower social support were associated with greater mortality only among individuals with longer LOS. For individuals with LOS ≥ 1 month, clinically elevated depressive symptoms (BDI-II ≥ 14) were associated with a threefold increased risk of mortality (HR = 2.97). Greater pretransplant depressive symptoms and lower social support may be associated with greater mortality among a subset of individuals with worse perioperative outcomes.
抑郁症状在肺移植候选者中很常见，并且在一些研究中与较差的临床结果有关。以前的研究受到方法学问题的困扰，包括样本量小、临床事件少和未控制的混杂因素，特别是围手术期并发症。此外，很少有研究探讨社会支持作为潜在的保护因素。因此，我们在大量肺移植受者中研究了移植前抑郁症状、社会支持与死亡率之间的关系。作为次要目的，我们还研究了心理社会因素与围手术期结局[以住院时间（LOS）为指标]和死亡率之间的关系。我们假设抑郁与 LOS 延长有关，并且抑郁、社会支持与死亡率之间的关系会受到 LOS 的调节。参与者包括 2009 年 1 月至 2014 年 12 月在杜克大学医学中心接受肺移植的患者。使用贝克抑郁量表（BDI-II）评估抑郁症状，使用感知社会支持量表（PSSS）评估社会支持。医疗风险因素包括用力肺活量（FVC）、二氧化碳分压（PCO ）、供体年龄、急性排斥和移植类型。使用六分钟步行距离（6MWD）评估功能状态。我们还控制了人口统计学因素，包括年龄、性别和原发疾病。移植住院 LOS 作为围手术期临床结局的标志物进行检查。参与者包括 273 名肺移植受者（174 名限制性、67 名阻塞性、26 名囊性纤维化和 6 名“其他”）。移植前抑郁症状很常见，56 名患者（21%）表现出临床升高的水平（BDI-II≥14）。抑郁症状越严重，LOS 越长[调整后的 b=0.20（BDI-II 每增加 7 分，LOS 增加 2 天），P<0.01]。LOS 调节了抑郁症状（P=0.019）、社会支持（P<0.001）与死亡率之间的关系，即只有 LOS 较长的个体中，较高的抑郁症状和较低的社会支持与更高的死亡率相关。对于 LOS≥1 个月的个体，临床升高的抑郁症状（BDI-II≥14）与死亡率增加三倍相关（HR=2.97）。在具有较差围手术期结局的个体亚组中，较大的移植前抑郁症状和较低的社会支持可能与更大的死亡率相关。
