The Combination of Insulin Resistance and Serum Interleukin-1β Correlates with Post-Stroke Depression in Patients with Acute Ischemic Stroke

Xiaoyi Yi; Xiangyang Zhu; Yong Zhou; Dongmei Zhang; Mengmeng Li; Yuting Zhu; Xiaoming Guo

doi:10.2147/NDT.S291164

The Combination of Insulin Resistance and Serum Interleukin-1β Correlates with Post-Stroke Depression in Patients with Acute Ischemic Stroke

Neuropsychiatr Dis Treat. 2021 Mar 9:17:735-746. doi: 10.2147/NDT.S291164. eCollection 2021.

Authors

Xiaoyi Yi¹, Xiangyang Zhu¹, Yong Zhou¹, Dongmei Zhang², Mengmeng Li², Yuting Zhu¹, Xiaoming Guo¹

Affiliations

¹ Deparment of Neurology, Affiliated Hospital 2 of Nantong University, Nantong, People's Republic of China.
² Clinical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, People's Republic of China.

Abstract

Purpose: Previous studies have shown that insulin resistance and inflammation may be associated with the pathophysiological mechanisms of mood disorders. Here, we investigated whether homeostatic model assessment of insulin resistance (HOMA-IR) and serum interleukin-1β (IL-1β) in acute ischemic stroke patients might be associated with post-stroke depression (PSD).

Materials and methods: The prospective study was conducted in China from February 2019 to September 2020. HOMA-IR and clinical data were collected at the time of admission. Serum levels of IL-1β were determined with enzyme-linked immunosorbent assays. Symptoms of depression and anxiety were screened by using the Hamilton Depression and Anxiety Scale at 6 months after stroke, and PSD was diagnosed on the basis of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. The association of potential risk factors with PSD was analyzed with multivariate logistic regression analysis. Finally, the ability of HOMA-IR and IL-1β to predict PSD was assessed with receiver operating characteristic curve.

Results: A total of 305 people was included in the study; 65% were male, and the median age was 69.5±11.8 years. At the 6-month follow-up, 113 patients (37.5%) showed depressive symptoms. In multivariate logistic regression analysis, HOMA-IR and IL-1β as graded variables were associated with an increased risk of PSD (P < 0.05). Receiver operating characteristic curve analysis indicated the highest sensitivity and specificity when the HOMA-IR and IL-1β were 1.96 and 38.71 pg/mL, respectively (P < 0.001). IL-1β improved the ability of HOMA-IR to diagnose PSD combined model area under the curve (AUC): 0.78; 95% CI: 0.72-0.83; P < 0.001).

Conclusion: This study suggests that HOMA-IR and IL-1β are strongly associated with PSD at 6 months after stroke in patients with acute ischemic stroke. These two factors together improve the ability for early PSD assessment.

Keywords: acute ischemic stroke; inflammation; insulin resistance; interleukin-1β; post-stroke depression.

Grants and funding

Funding was provided by the Scientific Research Project of the Health Commission of Jiangsu Province (H2019057) and the Nantong Science and Technology Project (MS12018042).