Predictive factors for post-cerebral infarction depression: A retrospective study of 156 patients

Table 1 Demographic and clinical characteristics of study participants, mean ± SD/n (%)

Characteristic	PSD group (n = 68)	Non-PSD group (n = 88)	P value
Age (years)	63.8 ± 11.5	65.7 ± 12.3	0.328
Female	39 (57.4)	33 (37.5)	0.012
BMI (kg/m2)	24.6 ± 3.2	24.1 ± 3.5	0.371
Education level			0.358
Primary or below	30 (44.1)	33 (37.5)
Secondary	26 (38.2)	36 (40.9)
College or above	12 (17.6)	19 (21.6)
Married	55 (80.9)	76 (86.4)	0.348
Urban residence	38 (55.9)	50 (56.8)	0.905
Employed	28 (41.2)	42 (47.7)	0.408
Comorbidities
Hypertension	46 (67.6)	54 (61.4)	0.414
Diabetes mellitus	20 (29.4)	22 (25.0)	0.539
Hyperlipidemia	22 (32.4)	25 (28.4)	0.588
Coronary heart disease	12 (17.6)	13 (14.8)	0.626
Atrial fibrillation	9 (13.2)	10 (11.4)	0.719
Previous stroke	11 (16.2)	9 (10.2)	0.265
Psychiatric history	13 (19.1)	5 (5.7)	0.007
Family psychiatric history	8 (11.8)	4 (4.5)	0.085
Smoking	20 (29.4)	24 (27.3)	0.766
Alcohol use	14 (20.6)	15 (17.0)	0.570
SSRS score	30.8 ± 7.5	39.2 ± 8.8	< 0.001

BMI: Body mass index; SSRS: Social Support Rating Scale; PSD: Post-stroke depression.

Table 2 Stroke-related clinical features, mean ± SD/n (%)

Stroke feature	PSD group (n = 68)	Non-PSD group (n = 88)	P value
NIHSS at admission	8.5 ± 2.6	4.8 ± 1.9	< 0.001
NIHSS at 2 weeks	5.8 ± 2.1	3.2 ± 1.5	< 0.001
Infarct location
Frontal lobe	23 (33.8)	14 (15.9)	0.008
Temporal lobe	12 (17.6)	18 (20.5)	0.656
Parietal lobe	10 (14.7)	15 (17.0)	0.687
Basal ganglia	18 (26.5)	20 (22.7)	0.583
Thalamus	8 (11.8)	7 (8.0)	0.420
Limbic system structures	21 (30.9)	12 (13.6)	0.005
Internal capsule	15 (22.1)	16 (18.2)	0.544
Brainstem	5 (7.4)	8 (9.1)	0.700
Cerebellum	3 (4.4)	5 (5.7)	0.723
Left hemisphere	43 (63.2)	39 (44.3)	0.017
TOAST classification			0.412
Large-artery atherosclerosis	25 (36.8)	28 (31.8)
Cardioembolism	12 (17.6)	14 (15.9)
Small-vessel occlusion	22 (32.4)	35 (39.8)
Other/undetermined	9 (13.2)	11 (12.5)
Onset to admission (hours)	4.8 ± 1.5	3.2 ± 1.0	0.008
SBP at admission (mmHg)	162.3 ± 21.5	151.8 ± 16.2	0.038
Glucose at admission (mmol/L)	7.8 ± 1.6	6.9 ± 1.2	0.025
mRS at 2 weeks	3.2 ± 0.9	1.9 ± 0.8	< 0.001
Barthel Index at 2 weeks	62.5 ± 14.8	81.2 ± 11.3	< 0.001
mRS at 3 months	2.5 ± 1.0	1.3 ± 0.7	< 0.001
Barthel Index at 3 months	72.8 ± 12.5	88.6 ± 9.2	< 0.001

NIHSS: National Institutes of Health Stroke Scale; TOAST: Trial of Org 10172 in Acute Stroke Treatment; SBP: Systolic blood pressure; mRS: Modified Rankin Scale; PSD: Post-stroke depression.

Table 3 Neuroimaging findings, mean ± SD/n (%)

Imaging feature	PSD group (n = 68)	Non-PSD group (n = 88)	P value
Infarct volume (cm3)	9.2 ± 3.1	5.1 ± 2.0	< 0.001
Multiple infarcts	28 (41.2)	25 (28.4)	0.089
White matter hyperintensities
Fazekas periventricular	2.1 ± 0.6	1.2 ± 0.5	< 0.001
Fazekas deep WM	1.9 ± 0.5	1.0 ± 0.4	< 0.001
Fazekas total score	4.0 ± 1.0	2.2 ± 0.8	< 0.001
Brain atrophy
GCA frontal	1.8 ± 0.6	1.1 ± 0.5	< 0.001
GCA parietal	1.3 ± 0.5	1.0 ± 0.4	0.065
MTA score	1.6 ± 0.7	1.0 ± 0.5	0.003
Global atrophy (GCA total)	1.5 ± 0.5	1.1 ± 0.4	0.012
Microbleed count	2.8 ± 1.9	1.5 ± 1.2	0.009
Perfusion parameters
ADC (× 10-3 mm2/second)	0.80 ± 0.11	0.90 ± 0.12	0.032
TTP (seconds)	122 ± 12	108 ± 9	0.018
CBF (mL/100 g/minutes)	32.5 ± 6.8	38.2 ± 7.5	0.028

WM: White matter; GCA: Global cortical atrophy; MTA: Medial temporal atrophy; ADC: Apparent diffusion coefficient; TTP: Time to peak; CBF: Cerebral blood flow; PSD: Post-stroke depression.

Table 4 Laboratory biomarkers in post-stroke depression and post-stroke depression groups, mean ± SD/n (%)

Biomarker	PSD group (n = 68)	Non-PSD group (n = 88)	P value
Inflammatory markers
IL-6 (pg/mL)	8.6 ± 2.1	4.2 ± 1.3	< 0.001
TNF-α (pg/mL)	16.8 ± 3.5	9.5 ± 2.2	< 0.001
hs-CRP (mg/L)	13.2 ± 4.1	7.8 ± 2.5	< 0.001
MCP-1 (pg/mL)	468 ± 72	372 ± 55	< 0.001
Neurotrophic factors
BDNF (ng/mL)	12.5 ± 3.8	22.7 ± 5.6	< 0.001
IGF-1 (ng/mL)	85.3 ± 20.5	118.6 ± 25.8	< 0.001
Neuroendocrine markers
Morning cortisol (nmol/L)	395.2 ± 98.7	318.4 ± 72.3	< 0.001
ACTH (pg/mL)	42.8 ± 8.5	34.6 ± 6.8	< 0.001
24 hours urinary cortisol (μg/24 hours)	125.3 ± 32.5	98.6 ± 24.8	< 0.001
Diurnal cortisol variation (%)	22.5 ± 5.3	36.8 ± 6.5	< 0.001
Cortisol awakening response	145.8 ± 35.2	182.5 ± 42.6	0.006
Metabolic markers
Homocysteine (μmol/L)	18.5 ± 5.2	13.8 ± 4.1	< 0.001
Folic acid (ng/mL)	6.2 ± 2.1	8.5 ± 2.8	< 0.001
Vitamin B12 (pg/mL)	285 ± 75	352 ± 90	0.003
HbA1c (%)	6.8 ± 1.2	6.3 ± 1.0	0.048
LDL-C (mmol/L)	3.2 ± 0.9	2.9 ± 0.8	0.102
Albumin (g/L)	36.5 ± 4.2	39.8 ± 3.8	0.015

IL: Interleukin; TNF: Tumor necrosis factor; hs-CRP: High sensitivity C-reactive protein; MCP-1: Monocyte chemoattractant protein-1; BDNF: Brain-derived neurotrophic factor; IGF-1: Insulin like growth factor-1; ACTH: Adrenocorticotropic hormone; HbA1c: Hlycated hemoglobin; LDL-C: Low-density lipoprotein cholesterol; PSD: Post-stroke depression.

Table 5 Independent predictors of post-stroke depression: Multivariate logistic regression

Variable	β	SE	Wald	OR (95%CI)	P value
Psychiatric history	1.348	0.298	20.45	3.85 (2.15-6.89)	< 0.001
Frontal lobe infarction	1.166	0.273	18.23	3.21 (1.88-5.48)	< 0.001
BDNF < 15.8 ng/mL	1.088	0.280	15.10	2.97 (1.72-5.13)	< 0.001
NIHSS ≥ 8	0.986	0.269	13.42	2.68 (1.58-4.54)	< 0.001
Female gender	0.896	0.244	13.48	2.45 (1.52-3.95)	0.001
Low social support	0.838	0.263	10.15	2.31 (1.38-3.87)	0.002
IL-6 > 6.5 pg/mL	0.779	0.285	7.48	2.18 (1.25-3.81)	0.006
Left hemisphere lesion	0.668	0.282	5.61	1.95 (1.12-3.39)	0.018
Non-significant variables
Homocysteine > 15 μmol/L	0.512	0.295	3.01	1.67 (0.94-2.97)	0.083
Morning cortisol > 360 nmol/L	0.598	0.312	3.67	1.82 (0.99-3.35)	0.055
WMH Fazekas ≥ 4	0.425	0.278	2.34	1.53 (0.89-2.63)	0.126
Diabetes mellitus	0.382	0.265	2.08	1.47 (0.87-2.47)	0.149
Previous stroke	0.356	0.312	1.30	1.43 (0.78-2.63)	0.254
Admission glucose > 7.0	0.298	0.258	1.33	1.35 (0.81-2.24)	0.248

Hosmer-Lemeshow test: χ² = 6.82, P = 0.556. BDNF: Brain-derived neurotrophic factor; NIHSS: National Institutes of Health Stroke Scale; IL: Interleukin; WMH: White matter hyperintensities; OR: Odds ratio; CI: Confidence interval.

Table 6 Clinical and biomarker characteristics stratified by depression severity, mean ± SD/n (%)

Characteristic	Mild (n = 31)	Moderate (n = 25)	Severe (n = 12)	P value
HAMD-17 score	11.2 ± 2.8	19.5 ± 1.8	28.3 ± 3.5	< 0.001
PHQ-9 score	8.5 ± 2.2	14.8 ± 2.5	21.2 ± 3.8	< 0.001
NIHSS at admission	7.2 ± 2.0	9.0 ± 2.3	10.2 ± 2.8	0.003
Infarct volume (cm3)	7.5 ± 2.5	9.8 ± 3.0	11.5 ± 3.8	0.001
Frontal lobe infarct, %	25.8	36.0	50.0	0.018
Left hemisphere, %	54.8	68.0	75.0	0.028
mRS at 3 months	2.0 ± 0.8	2.8 ± 0.9	3.5 ± 1.1	< 0.001
Barthel Index at 3 months	78.5 ± 10.2	70.2 ± 12.5	60.5 ± 15.8	< 0.001
Biomarkers
BDNF (ng/mL)	15.2 ± 3.5	11.0 ± 3.2	8.2 ± 2.5	< 0.001
IL-6 (pg/mL)	7.0 ± 1.8	9.2 ± 2.0	11.3 ± 2.8	< 0.001
TNF-α (pg/mL)	14.2 ± 3.0	17.5 ± 3.2	21.8 ± 4.5	< 0.001
hs-CRP (mg/L)	10.8 ± 3.5	14.2 ± 4.0	17.5 ± 5.2	< 0.001
Morning cortisol (nmol/L)	365 ± 85	405 ± 95	445 ± 110	0.003
Homocysteine (μmol/L)	16.5 ± 4.5	19.2 ± 5.0	22.8 ± 6.5	0.002
SSRS score	33.5 ± 6.8	29.2 ± 7.5	26.5 ± 6.2	0.005
Fazekas total score	3.5 ± 0.9	4.2 ± 1.0	4.8 ± 1.2	0.006

P values were calculated using the Jonckheere-Terpstra test for ordered alternatives. HAMD-17: 17-item Hamilton Depression Rating Scale; PHQ-9: Patient Health Questionnaire-9; NIHSS: National Institutes of Health Stroke Scale; mRS: Modified Rankin Scale; BDNF: Brain-derived neurotrophic factor; IL: Interleukin; TNF: Tumor necrosis factor; hs-CRP: High sensitivity C-reactive protein; SSRS: Social Support Rating Scale.