Prevalence and correlates of low-grade systemic inflammation in adult psychiatric inpatients: An electronic health record-based study

Psychoneuroendocrinology. 2018 May;91:226-234. doi: 10.1016/j.psyneuen.2018.02.031. Epub 2018 Mar 1.

Abstract

Low-grade inflammation is a risk factor for depression, psychosis and other major psychiatric disorders. It is associated with poor response to antidepressant and antipsychotics, and could potentially be a treatment target. However, there is limited data on the prevalence of low-grade inflammation in major psychiatric disorders, and on the characteristics of patients who show evidence of inflammation. We examined the prevalence of low-grade inflammation and associated socio-demographic and clinical factors in acute psychiatric inpatients. An anonymised search of the electronic patient records of Cambridgeshire and Peterborough NHS Foundation Trust was used to identify patients aged 18-65 years who were hospitalised between 2013 and 2016 (inclusive). We excluded patients on antibiotics or oral steroids, or with missing data. Inflammation was defined using serum C-reactive protein (>3 mg/L) or total white cell count (>9.4 × 109/L) as measured within 14 days of admission. Out of all 599 admissions, the prevalence of inflammation (serum CRP >3 mg/L) in the ICD-10 diagnostic groups of psychotic disorders (F20-29), mood disorders (F30-39), neurotic disorders (F40-48) and personality disorders (F60-69) was 32%, 21%, 22% and 42%, respectively. In multivariable analyses, low-grade inflammation was associated with older age, black ethnicity, being single, self-harm, diagnoses of schizophrenia, bipolar disorder, current treatments with antidepressants, benzodiazepines, and with current treatment for medical comorbidities. A notable proportion of acutely unwell psychiatric patients from all ICD-10 major diagnostic groups show evidence of low-grade inflammation, suggesting inflammation may be relevant for all psychiatric disorders.

Keywords: CRP; Depression; Immunopsychiatry; Inflammation; Psychosis; White cell count.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • C-Reactive Protein / analysis
  • Comorbidity
  • Cross-Sectional Studies
  • Electronic Health Records
  • Female
  • Humans
  • Inflammation / psychology*
  • Leukocyte Count
  • Leukocytes
  • Male
  • Mental Disorders / drug therapy
  • Mental Disorders / immunology*
  • Middle Aged
  • Prevalence
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / immunology

Substances

  • Antidepressive Agents
  • Antipsychotic Agents
  • C-Reactive Protein