Risk factors for anxiety and depression in elderly frail patients based on bedside ultrasound multimodal assessment

Table 1 Baseline characteristics of study subjects, n (%)/mean ± SD/mean (interquartile range)

Characteristics	Total (n = 125)	Low-risk (n = 56)	High-risk (n = 69)	P value
Age (years)	76.8 ± 8.5	75.6 ± 8.2	77.8 ± 8.7	0.158
Male gender	66 (52.8)	29 (51.8)	37 (53.6)	0.841
CFS score, median (range)	6 (5-8)	6 (5-7)	6 (5-8)	0.201
Low diaphragm thickness fraction (< 20%)	70 (56.0)	18 (32.1)	52 (75.4)	< 0.001
Reduced rectus femoris cross-sectional area (< 4.0 cm2)	61 (48.8)	15 (26.8)	46 (66.7)	< 0.001
Elevated inferior vena cava collapsibility index (> 50%)	45 (36.0)	12 (21.4)	33 (47.8)	0.002
Reduced cardiac output (< 4.0 L/minute)	36 (28.8)	10 (17.9)	26 (37.7)	0.016
Elevated lung ultrasound score (≥ 12 points)	55 (44.0)	14 (25.0)	41 (59.4)	< 0.001

Table 2 Univariate analysis of risk factors for anxiety and depression

Risk factor	Odds ratio	95%CI	P value	Significance
Age ≥ 80 years	2.56	1.22-5.37	0.013	Significant
Female gender	1.95	0.98-3.89	0.058	NS
Low diaphragm thickness fraction (< 20%)	3.92	1.82-8.44	< 0.001	Significant
Reduced rectus femoris cross-sectional area (< 4.0 cm2)	3.24	1.58-6.64	0.001	Significant
Elevated inferior vena cava collapsibility index (> 50%)	1.68	0.82-3.44	0.156	NS
Reduced cardiac output (< 4.0 L/minute)	1.52	0.72-3.21	0.272	NS
Elevated lung ultrasound score (≥ 12 points)	2.86	1.42-5.76	0.003	Significant

NS: Not significant.

Table 3 Correlation between ultrasound parameters and anxiety/depression severity

Parameter	HADS-anxiety r value	P value	HADS-depression r value	P value	Total r value
Diaphragm thickness fraction (%)	-0.428	< 0.001	-0.395	< 0.001	-0.438
Rectus femoris cross-sectional area (cm2)	-0.385	< 0.001	-0.412	< 0.001	-0.418
Inferior vena cava collapsibility index (%)	0.186	0.038	0.168	0.062	0.192
Cardiac output (L/minute)	-0.152	0.091	-0.178	0.047	-0.172
Lung ultrasound score (points)	0.362	< 0.001	0.345	< 0.001	0.378
Number of abnormal parameters	0.436	< 0.001	0.425	< 0.001	0.452

HADS: Hospital Anxiety and Depression Scale.

Table 4 Comparison of diagnostic performance of prediction models

Model	Area under the curve	95%CI	Sensitivity	Specificity	Positive predictive value/negative predictive value
DTF alone	0.682	0.59-0.77	71.4%	60.3%	53.6%/76.4%
RF-CSA alone	0.658	0.56-0.75	66.7%	62.8%	52.5%/75.4%
LUS alone	0.635	0.54-0.73	61.9%	65.4%	52.0%/74.0%
DTF + RF-CSA	0.728	0.64-0.82	73.8%	66.7%	57.4%/80.8%
DTF + RF-CSA + LUS	0.768	0.68-0.85	76.2%	70.5%	61.5%/82.7%
All 5 parameters	0.782	0.70-0.86	78.6%	69.2%	61.1%/84.2%
≥ 3 abnormal parameters	0.718	0.63-0.81	72.5%	70.8%	60.9%/80.4%

DTF: Diaphragm thickness fraction; LUS: Lung ultrasound score; RF-CSA: Rectus femoris cross-sectional area.

Table 5 Sensitivity analysis and subgroup analysis

Analysis	Subgroup	High-risk	Low-risk
Hospital Anxiety and Depression Scale ≥ 11 criteria	Overall (n = 125)	52.2% (36/69)	26.8% (15/56)
Gender-stratified	Male (n = 66)	48.6% (18/37)	24.1% (7/29)
Gender-stratified	Female (n = 59)	56.3% (18/32)	29.6% (8/27)
Age-stratified	≥ 80 years	OR = 4.82	95%CI: 1.76-13.18
Age-stratified	65-79 years	OR = 2.28	95%CI: 0.98-5.31

OR: Odds ratio.