Nomogram including indirect bilirubin for the prediction of post-stroke depression at 3 months after mild acute ischemic stroke onset

Yanyan Wang; Wenzhe Sun; Jinfeng Miao; Zhou Zhu; Wenwen Liang; Xiuli Qiu; Chensheng Pan; Guo Li; Yan Lan; Xin Zhao; Yi Xu

doi:10.3389/fneur.2023.1093146

Nomogram including indirect bilirubin for the prediction of post-stroke depression at 3 months after mild acute ischemic stroke onset

Front Neurol. 2023 Feb 8:14:1093146. doi: 10.3389/fneur.2023.1093146. eCollection 2023.

Authors

Yanyan Wang¹, Wenzhe Sun¹, Jinfeng Miao¹, Zhou Zhu¹, Wenwen Liang¹, Xiuli Qiu¹, Chensheng Pan¹, Guo Li¹, Yan Lan¹, Xin Zhao¹, Yi Xu²

Affiliations

¹ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
² Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Abstract

Background: Post-stroke depression (PSD) has been proven to be associated with stroke severity. Thus, we hypothesized that the prevalence of PSD would be lower in patients with mild stroke. We aim to explore predictors of depression at 3 months after mild acute ischemic stroke (MAIS) onset and to develop a practical and convenient prediction model for the early identification of patients at high risk.

Methods: A total of 519 patients with MAIS were consecutively recruited from three hospitals in Wuhan city, Hubei province. MAIS was defined as a National Institute of Health Stroke Scale (NIHSS) score of ≤5 at admission. Meeting the DSM-V diagnostic criteria and a 17-item Hamilton Rating Scale for Depression (HAMD-17) score of >7 at their 3-month follow-up were considered the primary outcomes. A multivariable logistic regression model was used to determine the factors adjusted for potential confounders, and all independent predictors were brought into the construction of a nomogram to predict PSD.

Results: The prevalence of PSD is up to 32% at 3 months after MAIS onset. After adjusting for potential confounders, indirect bilirubin (p = 0.029), physical activity (p = 0.001), smoking (p = 0.025), hospitalization days (p = 0.014), neuroticism (p < 0.001), and MMSE (p < 0.001) remained independently and significantly related with PSD. The concordance index (C-index) of the nomogram jointly constructed by the aforementioned six factors was 0.723 (95% CI: 0.678-0.768).

Conclusion: The prevalence of PSD seems equally high even if the ischemic stroke is mild, which calls for great concern from clinicians. In addition, our study found that a higher level of indirect bilirubin can lower the risk of PSD. This finding may provide a potential new approach to PSD treatment. Furthermore, the nomogram including bilirubin is convenient and practical to predict PSD after MAIS onset.

Keywords: indirect bilirubin; mild acute ischemic-stroke; nomogram; oxidative stress; post-stroke depression.

Grants and funding

This study was financially supported by the National Natural Science Fund of China (grant numbers 82171465, 82001218, and 82101605), the National Key R&D Program of China (grant number 2017YFC1310000), and the Hubei Technological Innovation Special Fund (grant number 2019ACA132). The funders had no role in study design, data collection and analysis, the decision to publish, and the preparation of the manuscript. XZ and YX had full access to all the data in the study and had final responsibility for the decision to submit for publication.