入院时较高的血浆纤维蛋白原水平与出院时的卒中后抑郁相关。
Higher Plasma Fibrinogen Level at Admission Is Associated with Post-Stroke Depression at Discharge.
作者信息
Zhu Juehua, Wang Li, Shao Han, Tang Xiang, Zhang Lulu, Zhou Yun, Jiang Yongjun, Fang Qi, Cai Xiuying
机构信息
Department of Neurology, The First Affiliated Hospital of SooChow University, Suzhou 215006, China.
Department of Neurology, Zhangjianggang Fifith People's Hospital, Suzhou 215600, China.
出版信息
Brain Sci. 2022 Aug 3;12(8):1032. doi: 10.3390/brainsci12081032.
Background: Post-stroke depression (PSD) is a common complication of stroke, which seriously affects the functional outcome of patients. Systemic low-grade inflammation associated with PSD has been shown to occur at several months to years, however, whether these inflammatory markers predicted PSD at an acute stage of stroke is controversial. Method: A total of 625 patients with acute ischemic stroke (219 female, 35.40%) were included in this study. PSD was diagnosed using the 17-item Hamilton depression scale (HAMD) at 7 days following discharge (7−14 days after stroke onset). Multivariable logistic regression analysis was applied to build a prediction model for PSD at discharge. Discrimination and calibration of the model were assessed by C-index, calibration plot. Internal validation was conducted using bootstrapping validation. Results: At discharge of hospitalization, 95 patients (15.20%) were diagnosed with PSD. Multivariable logistic regression suggested that female gender (OR = 2.043, 95% CI = 1.287−3.245, p = 0.002), baseline NIHSS (OR = 1.108, 95% CI = 1.055−1.165, p < 0.001) and fibrinogen (OR = 1.388, 95% CI = 1.129−1.706, p = 0.002) were independent predictors for PSD at discharge. The cut-off of the fibrinogen plasma level was 3.08 g/L. These predictors were included in the nomogram. The model displayed good discrimination, with a C-index of 0.730 (95% CI = 0.683−0.777) and good calibration. Conclusion: Female gender, baseline stroke severity and a higher level of fibrinogen were independently associated with PSD at discharge. A nomogram based on these three predictors can be used to provide an individual, visual prediction of the risk probability of PSD.
背景
卒中后抑郁(PSD)是卒中常见的并发症,严重影响患者的功能预后。与PSD相关的全身性低度炎症已被证明在数月至数年时出现,然而,这些炎症标志物在卒中急性期是否能预测PSD仍存在争议。方法:本研究共纳入625例急性缺血性卒中患者(女性219例,占35.40%)。出院后7天(卒中发病后7 - 14天)使用17项汉密尔顿抑郁量表(HAMD)诊断PSD。应用多变量逻辑回归分析建立出院时PSD的预测模型。通过C指数、校准图评估模型的区分度和校准度。采用自举验证法进行内部验证。结果:出院时,95例患者(15.20%)被诊断为PSD。多变量逻辑回归分析表明,女性(OR = 2.043,95%CI = (1.287 - 3.245),p = 0.002)、基线美国国立卫生研究院卒中量表(NIHSS)评分(OR = 1.108,95%CI = (1.055 - 1.165),p < 0.001)和纤维蛋白原(OR = 1.388,95%CI = (1.129 - 1.706),p = 0.002)是出院时PSD的独立预测因素。血浆纤维蛋白原水平的截断值为3.08 g/L。这些预测因素被纳入列线图。该模型显示出良好的区分度,C指数为(0.730,95%CI = (0.683 - 0.777)),且校准良好。结论:女性、基线卒中严重程度和较高水平的纤维蛋白原与出院时的PSD独立相关。基于这三个预测因素的列线图可用于提供PSD风险概率的个体化、可视化预测。