Nomogram for Persistent Post-Stroke Depression and Decision Curve Analysis

Figures & data

Table 1 Incidence of Depression in Stroke Patients

Time Point	No. of Patients	Patients of Newly Occurring PSD	PSD Cumulative Incidence (%)	PSD Newly Occurring Incidence (%)	Transient PSD	Persistent PSD	Recurrent PSD
14d	875	301	34.4	34.4	70	193	38
84d	574	113	47.3	19.7	52	56	5
182d	461	59	54.1	12.8	19	40	/
360d	402	40	58.6	10.0	40	/	/

Figure 1 Flow chart of the research.

Table 2 Comparison of Baseline Characteristics Between Persistent PSD and Others

	Persistent PSD (n=289)	Others (n=586)	Univariate Analysis	Multivariate Analysis
			P value	P value	OR	95% CI
Sociodemographic indicators Gender, female (n,%)	71(24.6%)	117(20.0%)	0.125
Age, years, median (IQR)	59(55–65)	59(53–66)	0.683
Education, high school or above (n,%)	105(68.1%)	230(39.2%)	0.330
Married (n,%)	279(96.5%)	543(92.7%)	0.047*
BMI, median (IQR)	24.56(22.49–26.44)	24.51(22.68–26.42)	0.907
Vascular risk factors
Diabetes (n,%)	76(26.3%)	161(27.5%)	0.713
Hypertension (n,%)	179(61.9%)	358(61.1%)	0.809
Smoking (n,%)	129(44.6%)	269(45.9%)	0.723
Drinking (n,%)	153(52.9%)	327(55.8%)	0.424
Hyperlipemia (n,%)	62(21.5%)	140(23.9%)	0.421
CHD (n,%)	29(10%)	50(8.5%)	0.466
Clinical information
NIHSS score, median (IQR)	3(2–6)	3(1–5)	0.030*
CES-D score, median (IQR)	13(8–20)	12(6–17)	0.008*
N dimension, median (IQR)	9(5–12)	8(4–11)	0.003*
MMSE score, median (IQR)	25(22–28)	26(23–29)	0.007*
HAMD-17 score, median (IQR)	8(4–14)	6(3–11)	<0.001*	0.011*	1.031	1.007–1.056
CD-RISC score, median (IQR)	64(52–76)	64(55–75)	0.441
SSRS score, median (IQR)	39(32–44)	37(31–43)	0.053
Biochemical indicators
Albumin, median (IQR)	40.61(38.60–42.80)	40.61(38.60–42.80)	0.787
Globulin, median (IQR)	28.03(25.70–29.90)	28.03(25.30–30.10)	0.763
Direct bilirubin, median (IQR)	3.80(2.70–4.65)	3.77(2.70–4.70)	0.039*	0.046*	0.924	0.855–0.998
Indirect bilirubin, median (IQR)	8.20(5.40–9.90)	8.48(5.80–10.20)	0.398
LDH, median (IQR)	187.00(159.50–208.50)	182.00(156.75–198.95)	0.092
HCY, median (IQR)	14.00(11.95–16.60)	14.65(11.60–16.60)	0.949
CRP, median (IQR)	3.60(1.10–7.41)	5.96(1.40–7.41)	0.061
TSH, median (IQR)	2.22(1.23–2.35)	2.05(1.22–2.48)	0.706
FT4, median (IQR)	1.09(0.96–4.39)	4.39(1.00–8.39)	<0.001*	0.001*	0.946	0.916–0.977
APTT, median (IQR)	34.50(32.65–37.35)	33.38(27.90–36.72)	<0.001*	0.001*	1.048	1.020–1.076
Fibrinogen, median (IQR)	3.34(2.89–3.74)	3.30(2.71–3.61)	0.029*
Cytokines
TNF-alpha, median (IQR)	45.00(24.87–58.54)	43.63(23.69–52.95)	0.591
IL-10, median (IQR)	10.05(3.99–42.23)	11.36(3.93–43.60)	0.083
IL-6, median (IQR)	5.75(2.12–12.73)	5.93(2.43–16.04)	0.162
IL-1β, median (IQR)	76.03(32.97–176.37)	107.62(35.51–181.92)	0.190
IL18, median (IQR)	2012.57(993.32–4522.39)	2642.48(1095.28–3914.49)	0.014*
BDNF, median (IQR)	3.60(2.17–7.10)	5.04(2.37–7.10)	0.029*

Note: *p<0.05.

Abbreviations: OR, odds ratio; CI, confidence interval; IQR, interquartile range; BMI, body mass index; CHD, coronary heart disease; NIHSS, National Institutes of Health Stroke Scale; CES-D, Center for Epidemiologic Studies Depression Scale; N, neuroticism; MMSE, Mini-Mental State Examination; HAMD-17, Hamilton Depression Scale-17 items; CD-RISC, Connor–Davidson resilience scale; SSRS, Social Support Rating Scale; LDH, lactate dehydrogenase; HCY, homocysteine; CRP, C-reactive protein; TSH, thyroid-stimulating hormone; FT4, free serum thyroxine level; APTT, activated partial thromboplastin time; TNF, tumor necrosis factor; IL, interleukin; BDNF, brain-derived neurotrophic factor.

Figure 2 Nomogram predicting persistent depression in 1-year time course after stroke.

Abbreviations: FT4, free serum thyroxine level; APTT, activated partial thromboplastin time; HAMD, Hamilton Depression Scale-17 items.

Figure 3 Calibration plots of the nomogram.

Figure 4 Decision curve analysis of the model.