C-reactive protein and post-stroke depressive symptoms

Kowalska, Katarzyna; Pasińska, Paulina; Klimiec-Moskal, Elżbieta; Pera, Joanna; Słowik, Agnieszka; Klimkowicz‐Mrowiec, Aleksandra; Dziedzic, Tomasz

doi:10.1038/s41598-020-58478-6

Cited by 20 publications

(21 citation statements)

References 35 publications

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“…Patients from Group 2 (D+/D −) were also more likely to have history of stroke or TIA compared with other groups. Our previous study showed that a history of stroke is a predictor of early, but not late post-stroke depressive symptoms (Kowalska et al 2020 ). In contrast, Eriksson et al found an association between a history of stroke and self-reported depression 3 months after stroke (Eriksson et al 2004 ).…”

Section: Discussionmentioning

confidence: 97%

Association of early and later depressive symptoms with functional outcome after ischemic stroke

et al. 2021

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Background Post-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms. Methods Of 698 enrolled patients with ischemic stroke, we included 335 participants (median age: 68, 48% female) who were assessed for DS both 8 days and 3 months post-stroke. We divided patients into 4 groups: without greater DS (Group 1), only earlier DS (Group 2), only later DS (Group 3), and persistent DS (Group 4). Logistic regression was used to determine the association between DS and 3- and 12-month functional outcome. Results Group 2 was predominantly female and had the highest rate of previous stroke or transient ischemic attack. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms, and cognitive decline. In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64–4.07, P < 0.01 and OR 3.97, 95% CI 2.32–6.76, P < 0.01, respectively) compared with Group 1. Conclusions Different trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.

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Section: Discussionmentioning

confidence: 97%

Association of early and later depressive symptoms with functional outcome after ischemic stroke

et al. 2021

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“…A few studies have examined the relationship between circulating CRP and risk of post-stroke depression with conflicting results [ 42 , 43 , 44 ]. In the previous sub-study, we found that this association was significant for depression diagnosed during hospitalization, but there was no association between depression diagnosed three months post-stroke and CRP levels [ 45 ]. Interestingly, in this present, much larger study, patients with depression, diagnosed at the hospital, had significantly higher level of CRP than dementia-free patients, thus supporting the hypothesis of the role of immunological mechanisms in development of depressive symptoms.…”

Section: Discussionmentioning

confidence: 98%

Early Depression Independently of Other Neuropsychiatric Conditions, Influences Disability and Mortality after Stroke (Research Study—Part of PROPOLIS Study)

et al. 2020

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Post-stroke depression (PSD) is the most frequent neuropsychiatric consequence of stroke. The nature of the relationship between PSD and mortality still remains unknown. One hypothesis is that PSD could be more frequent in those patients who are more vulnerable to physical disability, a mediator variable for higher level of physical damage related to higher risk of mortality. Therefore, the authors’ objective was to explore the assumption that PSD increases disability after stroke, and secondly, that mortality is higher among patients with PSD regardless of stroke severity and other neuropsychiatric conditions. We included 524 consecutive patients with acute stroke or transient ischemic attack, who were screened for depression between 7–10 days after stroke onset. Physical impairment and death were the outcomes measures at evaluation check points three and 12 months post-stroke. PSD independently increased the level of disability three (OR = 1.94, 95% CI 1.31–2.87, p = 0.001), and 12 months post-stroke (OR = 1.61, 95% CI 1.14–2.48, p = 0.009). PSD was also an independent risk factor for death three (OR = 5.68, 95% CI 1.58–20.37, p = 0.008) and 12 months after stroke (OR = 4.53, 95% CI 2.06–9.94, p = 0.001). Our study shows the negative impact of early PSD on the level of disability and survival rates during first year after stroke and supports the assumption that depression may act as an independent mediator for disability leading to death in patients who are more vulnerable for brain injury.

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“… 42 Kowalska et al found that higher levels of CRP are associated with greater depressive symptoms after stroke. 43 A meta-analysis of previous prospective and retrospective studies showed that higher level of CRP in the acute phase of stroke suggested an increased risk for PSD. 11 Inflammation is conducive to dysfunction of synaptic plasticity and ultimately depression by mediating alterations in neurotransmitters, particularly the synthesis and metabolism of 5-hydroxytryptamine and glutamine.…”

Section: Discussionmentioning

confidence: 99%

Elevated Red Blood Cell Distribution Width Levels at Admission Predicts Depression After Acute Ischemic Stroke: A 3-Month Follow-Up Study

Li¹,

Zhang²,

Dong³

et al. 2022

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Purpose Red blood cell distribution width (RDW) is closely related to inflammatory-related disease markers. The present study aimed to investigate the association between the red blood cell distribution width (RDW) and post-stroke depression (PSD). Patients and Methods A total of 414 patients with acute ischemic stroke (AIS) admitted to our hospital from June 2018 to July 2021 were consecutively enrolled and received 3 months’ follow-up. According to the 17-item Hamilton Depression Scale (HAMD) assessment, they were divided into PSD group and non-PSD group. Diagnosis of PSD was made in accordance with DSM-IV. RDW was recorded within 24 hours of admission. Results Among the included 414 patients, 95 (22.95%) patients were diagnosed as having PSD at 3 months after stroke. The results showed significantly higher level of RDW in patients with depression (13.69 (IQR13.24–13.88) vs. 13.56 (IQR 12.67–13.77), P<0.001) at admission than patients without depression. After adjustment for potential confounding factors, the odds ratio of PSD was 5.707 (95% CI, 2.717–11.989) for the highest tertile of RDW compared with the lowest tertile. Moreover, based on the receiver operating characteristic (ROC) curve, the optimal cutoff of RDW levels as an indicator for the prediction of PSD was projected as 13.01, which yielded a sensitivity of 83% and a specificity of 41.0%, with an area under the curve (AUC) of 0.643 (95% CI, 0.585–0.701; P = 0.012). Conclusion Higher RDW levels at admission were found to be correlated with PSD 3 months after stroke.

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C-reactive protein and post-stroke depressive symptoms

Cited by 20 publications

References 35 publications

Association of early and later depressive symptoms with functional outcome after ischemic stroke

Association of early and later depressive symptoms with functional outcome after ischemic stroke

Early Depression Independently of Other Neuropsychiatric Conditions, Influences Disability and Mortality after Stroke (Research Study—Part of PROPOLIS Study)

Elevated Red Blood Cell Distribution Width Levels at Admission Predicts Depression After Acute Ischemic Stroke: A 3-Month Follow-Up Study

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