The Association Between Systemic Inflammatory Markers and Post-Stroke Depression: A Prospective Stroke Cohort

Abstract

Objective

Inflammation plays an important role in stroke. Many inflammatory markers in peripheral blood are proved to be associated with stroke severity or prognosis. But few comprehensive models or scales to evaluate the post-stroke depression (PSD) have been reported. In this study, we aimed to compare the level of systemic inflammation markers between PSD and non-PSD patients and explore the association of these inflammatory markers with PSD.

Methods

Totally, 432 ischemic stroke patients were consecutively enrolled in the study and received 1 month follow-up. We used the 17-Hamilton Rating Scale to measure depressive symptoms at 1 month after stroke. With the Hamilton Depression Scale score of >7, patients were diagnosed with PSD. Systemic immune-inflammation index (SII), neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR) and derived neutrophil-to-lymphocyte ratio (dNLR) were calculated from the admission blood work.

Results

Finally, 129 patients (30.5%) were diagnosed with PSD at 1 month. PSD patients showed significantly higher levels of SII (501.27 (345.43–782.58) vs 429.60 (315.64–570.98), P=0.001), NLR (2.36 (1.77–3.82) vs 2.17 (1.56–2.80), P=0.010), dNLR (1.67 (1.30–2.51) vs 1.54 (1.16–1.99), P=0.009), PLR (124.65 (95.25–155.15) vs 109.22 (92.38–142.03), P=0.015), especially SII at admission as compared to non-PSD patients. In the logistic analysis, SII value (>547.30) was independently associated with the occurrence of PSD (OR=2.181, 95% CI=1.274–3.732, p =0.004), better than dNLR (OR=1.833, 95% CI=1.071–3.137, p =0.027), PLR (OR= 1.822, 95% CI=1.063–3.122, p =0.029) and NLR (OR =1.728, 95% CI=1.009–2.958, p =0.046).

Conclusion

Increased SII, PLR, dNLR, NLR, particularly SII at admission, are significantly correlated with PSD and may add some prognostic clues to find early discovery of PSD.

Keywords:

• inflammatory markers
• post-stroke depression
• systemic immune-inflammation index
• neutrophil-to-lymphocyte
• platelet-to-lymphocyte
• derived neutrophil-to-lymphocyte ratio

Acknowledgments

We thank all staff members, patients and their families for their support and involvement in the study. Jingjie Hu and Liuyuan Wang are co-first authors in this study.

Ethics Statement

This study obtained the approval by the Medical Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University. Patients all signed the written informed consents before participating in our study. The study project conforms to the ethical guidelines of the Declaration of Helsinki. The data was kept confidential and not shared.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships and a potential conflict of interest.