Peripheral inflammation and trajectories of depressive symptomology after ischemic stroke: A prospective cohort study

Wenzhe Sun; Zhaoxia Yang; Yanyan Wang; Jinfeng Miao; Chensheng Pan; Guo Li; Wenwen Liang; Xin Zhao; Yan Lan; Xiuli Qiu; Hao Wang; Man Chen; Yuan Yang

doi:10.1016/j.jad.2024.05.045

Peripheral inflammation and trajectories of depressive symptomology after ischemic stroke: A prospective cohort study

J Affect Disord. 2024 May 8:359:14-21. doi: 10.1016/j.jad.2024.05.045. Online ahead of print.

Authors

Wenzhe Sun¹, Zhaoxia Yang², Yanyan Wang³, Jinfeng Miao⁴, Chensheng Pan³, Guo Li³, Wenwen Liang³, Xin Zhao⁵, Yan Lan³, Xiuli Qiu³, Hao Wang⁶, Man Chen³, Yuan Yang⁷

Affiliations

¹ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China.
² Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan 430030, China.
³ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan 430030, China.
⁴ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan 430030, China. Electronic address: m201875948@hust.edu.cn.
⁵ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan 430030, China. Electronic address: 2018tj5452@hust.edu.cn.
⁶ Department of Neurology, General Hospital of the Yangtze River Shipping, No.5 Huiji Road, Wuhan 430030, China.
⁷ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan 430030, China. Electronic address: yuanyang70@hotmail.com.

PMID: 38729221
DOI: 10.1016/j.jad.2024.05.045

Abstract

Background: Understanding the association of peripheral inflammation and post-stroke depressive symptomology (PSDS) might provide further insights into the complex etiological mechanism of organic depression. However, studies focusing on the longitudinal patterns of PSDS were limited and it remained unclear whether peripheral inflammation influences the occurrence and development of PSDS.

Methods: A total of 427 prospectively enrolled and followed ischemic stroke patients were included in the analytical sample. Depressive symptomology was assessed on four occasions during 1 year after ischemic stroke. Peripheral inflammatory proteins on admission and repeated measures of peripheral immune markers in three stages were collected. Latent class growth analysis (LCGA) was employed to delineate group-based trajectories of peripheral immune markers and PSDS. Multinomial regression was performed to investigate the association of peripheral inflammation with PSDS trajectories.

Results: Four distinct trajectories of PSDS were identified: stable-low (n = 237, 55.5 %), high-remitting (n = 120, 28.1 %), late-onset (n = 44, 10.3 %), and high-persistent (n = 26, 6.1 %) PSDS trajectories. The elevation of peripheral fibrinogen on admission increased the risk of high-persistent PSDS in patients with early high PSDS. Additionally, chronic elevation of innate immune levels might not only increase the risk of high-persistent PSDS in patients with early high PSDS but also increase the risk of late-onset PSDS in patients without early high PSDS. The elevation of adaptive immune levels in the convalescence of ischemic stroke may contribute to the remission of early high PSDS.

Conclusions: Peripheral immunity could influence the development of PSDS, and this influence might have temporal heterogeneity. These results might provide vital clues for the inflammation hypothesis of PSD.

Keywords: Depressive symptomology; Group-based trajectories; Inflammatory proteins; Ischemic stroke; Peripheral immunity.