Li Qing-Zhong, Tan Jia-Xin, Ruan Guo-Tian, Qin Quan-Zhi, Deng Teng, Gong Yi-Zhen
Guangxi Medical University Cancer Hospital, Nanning, 530021, Guangxi, China.
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
BMC Psychiatry. 2025 Jul 1;25(1):660. doi: 10.1186/s12888-025-07082-x.
Depression has been recognized as a leading global contributor to disease burden and mortality. While the etiology of depression involves a complex interplay of biological, psychological, and social factors, its precise pathophysiological mechanisms remain incompletely understood. The albumin-bilirubin (ALBI) score, originally developed as an objective measure of hepatic function, has demonstrated prognostic value in diverse clinical contexts including liver diseases, brain tumors and chronic heart failure. However, the relationship between ALBI scores and depression has not been systematically investigated. This study aims to examine the association between ALBI scores and depression in a nationally representative cohort.
This population-based cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning seven survey cycles (2005-2018). The ALBI score was calculated using the established formula: ALBI = (log10 bilirubin [μmol/L] × 0.66) + (albumin [g/L] × -0.085). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Weighted multivariable logistic regression models were constructed to analyze the association between ALBI and depression, adjusting for potential covariates. Nonlinear relationships were explored using restricted cubic splines (RCS). The robustness of the results was validated through subgroup analyses. The relationship between ALBI and depression symptoms severity was evaluated via ANOVA. For prognostic analysis, Cox proportional hazards regression models assessed the link between ALBI and clinical outcomes, complemented by Kaplan-Meier (K-M) survival curves and RCS plots to illustrate trends.
Weighted multivariable logistic regression models revealed a significant association between elevated ALBI scores and depression risk. Participants in the higher ALBI (ALBI≧ -2.87) demonstrated 16% increased odds of depression compared to the reference (ALBI < -2.87) (adjusted OR = 1.16, 95% CI 1.03-1.31, P = 0.01). Restricted cubic spline analysis confirmed a linear relationship between continuous ALBI scores and depression risk. Subgroup analyses stratified by age, gender, race, education, smoking, drinking and diabetes consistently identified high ALBI as an independent risk factor for depression. The analysis of variance revealed a significant dose-response relationship between ALBI and depression symptom severity (P < 0.05). Cox proportional hazards models revealed significant associations between ALBI increments and mortality risks in the depression cohort. For all-cause mortality, each 1-unit ALBI elevation was associated with a 284% increased risk (adjusted HR = 3.84, 95% CI 2.77-5.33, P < 0.01). Cancer-related mortality showed a 235% risk escalation per ALBI unit (HR = 3.35, 95% CI 1.54-7.26, P < 0.01), while non-cancer deaths exhibited an stronger association at 296% increased risk (HR = 3.96, 95% CI 2.76-5.67, P < 0.01).
By analyzing data from seven cycles (2005-2018) of the NHANES database, this study identified a positive association between the ALBI score and depression among U.S. adults. The ALBI score was also linked to the severity of depressive symptoms, and was associated with all-cause mortality, cancer-related mortality in individuals with depression.
Clinical trial number: not applicable.
抑郁症已被公认为全球疾病负担和死亡率的主要促成因素。虽然抑郁症的病因涉及生物、心理和社会因素的复杂相互作用，但其确切的病理生理机制仍未完全了解。白蛋白-胆红素（ALBI）评分最初是作为肝功能的客观指标而开发的，已在包括肝病、脑肿瘤和慢性心力衰竭在内的多种临床环境中显示出预后价值。然而，ALBI评分与抑郁症之间的关系尚未得到系统研究。本研究旨在调查具有全国代表性的队列中ALBI评分与抑郁症之间的关联。
这项基于人群的横断面研究利用了国家健康与营养检查调查（NHANES）七个调查周期（2005-2018年）的数据。使用既定公式计算ALBI评分：ALBI =（log10胆红素[μmol/L]×0.66）+（白蛋白[g/L]× -0.085）。使用患者健康问卷-9（PHQ-9）评估抑郁症。构建加权多变量逻辑回归模型以分析ALBI与抑郁症之间的关联，并对潜在的协变量进行调整。使用受限立方样条（RCS）探索非线性关系。通过亚组分析验证了结果的稳健性。通过方差分析评估ALBI与抑郁症状严重程度之间的关系。对于预后分析，Cox比例风险回归模型评估ALBI与临床结局之间的联系，并辅以Kaplan-Meier（K-M）生存曲线和RCS图以说明趋势。
加权多变量逻辑回归模型显示，ALBI评分升高与抑郁风险之间存在显著关联。与参考组（ALBI < -2.87）相比，较高ALBI（ALBI≧ -2.87）的参与者患抑郁症的几率增加了16%（调整后的OR = 1.16，95%CI 1.03-1.31，P = 0.01）。受限立方样条分析证实了连续ALBI评分与抑郁风险之间的线性关系。按年龄、性别、种族、教育程度、吸烟、饮酒和糖尿病分层的亚组分析一致确定高ALBI是抑郁症的独立危险因素。方差分析显示ALBI与抑郁症状严重程度之间存在显著的剂量反应关系（P < 0.05）。Cox比例风险模型显示，抑郁症队列中ALBI升高与死亡风险之间存在显著关联。对于全因死亡率，ALBI每升高1个单位，风险增加284%（调整后的HR = 3.84，95%CI 2.77-5.33，P < 0.01）。癌症相关死亡率显示每ALBI单位风险升高235%（HR = 3.35，95%CI 1.54-7.26，P < 0.01），而非癌症死亡显示出更强的关联，风险增加296%（HR = 3.96，95%CI 2.76-5.67，P < 0.01）。
通过分析NHANES数据库七个周期（2005-2018年）的数据，本研究发现美国成年人中ALBI评分与抑郁症之间存在正相关。ALBI评分还与抑郁症状的严重程度相关，并与抑郁症患者的全因死亡率、癌症相关死亡率相关。
临床试验编号：不适用。
