Higher Serum Lactic Dehydrogenase is Associated with Post-Stroke Depression at Discharge

Figures & data

Table 1 Baseline Characteristics of AIS Patients According to LDH Tertiles

Variables	All Patients, n=518	LDH Tertiles			P-Value
		Tertile 1, n=171 (102–159 U/L)	Tertile 2, n=173 (160–189 U/L)	Tertile 3, n=174 (190–520 U/L)
Serum LDH level (U/L), median (IQR)	173.5 (153.0, 202.0)	143.0 (133.0, 153.0)	173.0 (165.0, 181.5)	220.0 (202.0, 247.3)	<0.001
Sociodemographic parameters
Age (years), median (IQR)	59.0 (51.0, 65.0)	56.0 (50.0, 65.0)	59.0 (50.5, 65.0)	61.0 (52.0, 67.3)	0.177
Females, n (%)	115 (22.20)	28 (16.37)	35 (20.23)	52 (29.89)	0.008
BMI (kg/m^2), median (IQR)	24.67 (22.60, 26.79)	24.67 (22.79, 27.04)	24.51 (22.49, 26.49)	24.67 (22.49, 26.65)	0.520
Married, n (%)	493 (95.17)	161 (94.15)	164 (94.80)	168 (96.55)	0.560
Educational level					0.085
Junior middle school and below, n (%)	327 (63.13)	100 (58.48)	107 (61.85)	120 (68.97)
Senior high/polytechnic school, n (%)	116 (22.39)	39 (22.81)	38 (21.97)	39 (22.41)
Bachelor and above, n (%)	75 (14.48)	32 (18.71)	28 (16.18)	15 (8.62)
Vascular risk factors
History of smoking, n (%)	309 (59.65)	114 (66.67)	101 (58.38)	94 (54.02)	0.052
History of drinking, n (%)	302 (58.30)	103 (60.23)	104 (60.12)	95 (54.60)	0.477
History of diabetes, n (%)	133 (25.68)	59 (34.50)	44 (25.43)	30 (17.24)	0.001
History of hypertension, n (%)	296 (57.14)	94 (54.97)	107 (61.85)	95 (54.60)	0.308
History of hyperlipidemia, n (%)	122 (23.55)	42 (24.56)	36 (20.81)	44 (25.29)	0.574
History of coronary artery diseases, n (%)	51 (9.85)	15 (8.77)	14 (8.09)	22 (12.64)	0.308
History of previous stroke, n (%)	94 (18.15)	31 (18.13)	35 (20.23)	28 (16.09)	0.606
History of atrial fibrillation, n (%)	20 (3.86)	3 (1.75)	7 (4.05)	10 (5.75)	0.155
History of surgery, n (%)	155 (29.92)	60 (35.09)	40 (23.12)	55 (31.61)	0.044
Clinical characteristics
NIHSS score, median (IQR)	3 (1, 6)	3 (1, 5)	3 (1, 6)	3 (2, 7)	0.025
BI score, median (IQR)	90 (55, 100)	95 (65, 100)	90 (50, 100)	82.5 (45, 100)	0.005
mRS score, median (IQR)	2 (1, 4)	2 (1, 3)	2 (1, 4)	2 (1, 4)	0.008
HRSD score, median (IQR)	6 (3, 11)	5 (2, 9)	6 (3, 11)	7 (4, 12)	0.001
Hospitalization days, median (IQR)	11 (8, 14)	10 (8, 13)	10 (8, 13)	12 (9, 15)	0.003
Serum biochemistry
CRP (mg/L), median (IQR)	2.30 (0.70, 7.25)	1.90 (0.55, 7.20)	2.10 (0.65, 7.25)	3.00 (0.95, 7.25)	0.005
IL-1β (pg/mL), median (IQR)	62.28 (26.33, 157.21)	53.46 (23.77, 156.16)	74.25 (30.06, 167.93)	56.65 (23.40, 143.77)	0.112
IL-6 (pg/mL), median (IQR)	6.00 (2.43, 9.69)	5.59 (2.29, 8.22)	6.00 (2.99, 10.11)	6.00 (2.37, 10.04)	0.353
IL-10 (pg/mL), median (IQR)	8.27 (2.38, 21.58)	8.00 (2.25, 20.27)	8.76 (2.69, 27.13)	7.40 (1.85, 20.87)	0.326
IL-18 (pg/mL), median (IQR)	1970.36 (957.12, 4551.33)	1833.72 (1028.52, 4646.52)	2143.94 (985.27, 4035.00)	2121.54 (921.43, 5119.16)	0.865
TNF-α (pg/mL), median (IQR)	40.37 (23.20, 57.36)	41.57 (26.30, 60.93)	40.64 (23.45, 55.52)	38.42 (20.44, 54.72)	0.214
BDNF (ng/mL), median (IQR)	3.51 (2.10, 7.11)	3.81 (2.42, 8.61)	3.36 (2.14, 7.57)	3.15 (1.85, 6.86)	0.182
IFN-γ (pg/mL), median (IQR)	4.33 (1.73, 9.35)	3.44 (1.29, 6.99)	4.91 (2.25, 9.75)	4.23 (1.71, 8.53)	0.084

Table 2 Clinical and Sociodemographic Characteristics of Patients with PSD and Non-PSD at Discharge

Variables	PSD Patients (n=249)	Non-PSD Patients (n=269)	P-Value
Serum LDH level (U/L), median (IQR)	179.0 (158.0, 213.0)	168.0 (149.0, 195.0)	0.001
Sociodemographic parameters
Age (years), median (IQR)	61.0 (54.0, 67.0)	59.0 (51.0, 65.0)	<0.001
Females, n (%)	57 (22.89)	58 (21.56)	0.716
BMI (kg/m^2), median (IQR)	24.67 (22.86, 27.18)	24.67 (22.76, 26.77)	0.273
Married, n (%)	239 (95.98)	254 (94.42)	0.408
Educational level			0.004
Junior middle school and below, n (%)	164 (65.86)	163 (60.59)
Senior high/polytechnic school, n (%)	62 (24.90)	54 (20.07)
Bachelor and above, n (%)	23 (9.24)	52 (19.33)
Vascular risk factors
History of smoking, n (%)	142 (57.03)	167 (62.08)	0.241
History of drinking, n (%)	151 (60.64)	151 (56.13)	0.298
History of diabetes, n (%)	61 (24.50)	72 (26.77)	0.555
History of hypertension, n (%)	136 (54.62)	160 (59.48)	0.264
History of hyperlipidemia, n (%)	56 (22.49)	66 (24.54)	0.584
History of coronary artery diseases, n (%)	30 (12.05)	21 (7.81)	0.105
History of previous stroke, n (%)	49 (19.68)	45 (16.73)	0.384
History of surgery, n (%)	73 (29.32)	82 (30.48)	0.772
History of atrial fibrillation, n (%)	8 (3.21)	12 (4.46)	0.461
Clinical characteristics
NIHSS score, median (IQR)	8 (5,10)	2 (1, 4)	<0.001
BI score, median (IQR)	95 (65, 100)	100 (80, 100)	<0.001
mRS score, median (IQR)	4 (3, 4)	2 (1, 3)	<0.001
HRSD score, median (IQR)	13 (10, 18)	3 (2, 5)	<0.001
Hospitalization days, median (IQR)	12 (9, 15)	9 (8, 12)	<0.001
Serum biochemistry
CRP (mg/L), median (IQR)	2.40 (0.75, 7.25)	2.30 (0.60, 7.25)	0.319
IL-1β (pg/mL), median (IQR)	63.92 (30.00, 156.16)	62.03 (22.86, 163.83)	0.623
IL-6 (pg/mL), median (IQR)	5.75 (2.29, 9.95)	6.00 (2.69, 9.37)	0.947
IL-10 (pg/mL), median (IQR)	7.76 (2.14, 21.78)	9.16 (2.74, 21.60)	0.262
IL-18 (pg/mL), median (IQR)	1959.33 (951.89, 4530.10)	1975.92 (968.56, 4553.51)	0.922
TNF-α (pg/mL), median (IQR)	40.23 (22.12, 56.01)	40.41 (25.22, 58.12)	0.433
BDNF (ng/mL), median (IQR)	3.13 (1.94, 6.34)	3.82 (2.16, 8.44)	0.028
IFN-γ (pg/mL), median (IQR)	4.56 (1.89, 9.60)	3.86 (1.65, 8.80)	0.347

Table 3 Serum LDH Tertiles of Patients

Variable	PSD Patients (n=249)	Non-PSD Patients (n=269)	χ^2	P-Value
Serum LDH level (U/L)			11.595	0.003
Tertile 1, n=171 (102–159 U/L)	66	105	9.177	0.002
Tertile 2, n=173 (160–189 U/L)	84	89	0.025	0.876
Tertile 3, n=174 (190–520 U/L)	99	75	8.178	0.004

Table 4 Multivariate Adjusted ORs for the Association Between LDH Levels and PSD at Discharge

	Tertile	OR^a	95% CI	P-Value
Unadjusted	Middle	1.502	0.978–2.305	0.063
	Upper	2.100	1.366–3.228	0.001
Model 1^b	Middle	1.485	0.966–2.284	0.072
	Upper	2.007	1.301–3.095	0.002
Model 2^c	Middle	1.485	0.966–2.284	0.072
	Upper	2.007	1.301–3.095	0.002
Model 3^d	Middle	1.516	0.955–2.406	0.078
	Upper	1.601	1.002–2.558	0.042
Model 4^e	Middle	1.516	0.955–2.406	0.078
	Upper	1.601	1.002–2.558	0.042

Notes: ^aReference OR (1.000) is the lowest tertile of LDH for PSD. ^bModel 1: Adjusted for age, gender, educational level, body mass index and marital status. ^cModel 2: Adjusted for covariates from model 1 and further adjusted for history of smoking and drinking, medical history (coronary artery disease, diabetes mellitus, hyperlipidemia, hypertension, previous stroke, atrial fibrillation and surgery). ^dModel 3: Adjusted for covariates from model 2 and further adjusted for baseline NIHSS scores, mRS scores, Barthel Index scores, hospitalization days and hospital. ^eModel 4: Adjusted for covariates from model 3 and further adjusted for CRP, IL-1β, IL-6, IL-10, TNF-α, BDNF, IFN-γ and IL-18.

Abbreviations: OR, odds ratio; LDH, lactate dehydrogenase; PSD, post-stroke depression; CI, confidence interval.