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

You do realize that survivors don't want to hear you predicting their post stroke depression. They want protocols for 100% recovery that will prevent depression! 

Or are you that much of complete blithering idiots? Ok, the truth hurts, doesn't it?

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

Yanyan Wang¹, Wenzhe Sun¹, Jinfeng Miao¹, Zhou Zhu¹, Wenwen Liang¹, Xiuli Qiu¹, Chensheng Pan¹, Guo Li¹, Yan Lan¹, Xin Zhao^1* and Yi Xu^2*

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

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(You don't need to treat PSD if you prevent it by 100% recovery protocols). Furthermore, the nomogram including bilirubin is convenient and practical to predict PSD after MAIS onset.

Introduction

Post-stroke depression (PSD), as one of the most frequent psychiatric complications of cerebrovascular lesions, is closely linked to decreased functional status and higher mortality rates, which not only reduces the quality of life of patients but also places a heavy burden on caregivers (1–3). A new review reported that PSD prevalence was extremely high within 3 months after the acute event in the total stroke population (4), and our previously published literature showed that the overall prevalence of PSD at 3 months after stroke was up to 39.7% (5). Furthermore, a host of studies presented that there was a strong association between stroke severity and PSD (1, 2, 6).

In clinical practice, the National Institute of Health Stroke Scale (NIHSS) is widely used to evaluate the severity of stroke (7), and mild stroke was defined as an NIHSS score of ≤5 (8, 9). An interesting study showed that despite a low NIHSS, patients with mild stroke who have recovered well continue to experience psychological consequences such as PSD and fatigue (10). The prevalence of depression after a minor ischemic stroke has been reported to be 26% 1 year after the stroke onset (11). Without timely identification and proper treatment, patients with long-term mood disorders after mild stroke could have a worse quality of life and may find it difficult to return to work and their social activities (12).

Currently, the literature on predicting PSD after mild stroke is still relatively scarce, the lack of data in this field provided the impetus for the study reported herein. To this end, we examine the prevalence and explore independent predictors of depression at 3 months after mild acute ischemic stroke (MAIS) onset. Moreover, we are committed to establishing a practical predictive nomogram of PSD to guide clinical decision-making.