Serum alkaline phosphatase was independently associated with depression in patients with cerebrovascular disease

Xi Tao; Chen Yang; Juan He; Qianrong Liu; Siyuan Wu; Wenjing Tang; Jia Wang

doi:10.3389/fpsyt.2023.1184673

Serum alkaline phosphatase was independently associated with depression in patients with cerebrovascular disease

Front Psychiatry. 2023 Jul 4:14:1184673. doi: 10.3389/fpsyt.2023.1184673. eCollection 2023.

Authors

Xi Tao^{1

2

3}, Chen Yang¹, Juan He⁴, Qianrong Liu^{1

2}, Siyuan Wu¹, Wenjing Tang⁵, Jia Wang⁶

Affiliations

¹ Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan Province, China.
² Clinical Research Center for Cerebrovascular Disease Rehabilitation in Hunan Province, Changsha, Hunan Province, China.
³ Hunan Provincical Key Laboratory of Neurorestoratology, Hunan Normal University, Changsha, Hunan, China.
⁴ Department of Neurosurgery, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan Province, China.
⁵ Department of Rehabilitation, Rehabilitation Hospital of Hunan Province, Changsha, Hunan Province, China.
⁶ Department of Scientific Research, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan Province, China.

Abstract

Background and purpose: Blood markers have important value in the diagnosis of depressive disorders. Serum alkaline phosphatase (ALP) not only predicts stroke recurrence and poor functional prognosis in cerebrovascular disease (CVD) patients but also increases significantly in middle-aged women with depression. Thus, it has not been reported whether serum ALP is associated with the development of depression and/or vascular depression (VDe) in CVD patients.

Methods: This was a cross-sectional study of 353 CVD patients (stroke patients, n = 291; cerebral small vessel disease (CSVD) patients, n = 62). Baseline demographic information, fasting blood markers (such as blood counts, liver function, kidney function and lipids), and brain CT/MRI scans were collected. CVD patients were divided into non-depression, suspected vascular depression (SVD), and positive vascular depression (PVD) groups according to their Hamilton Rating Scale for Depression (HAMD) scores. Univariate analysis of baseline data, blood markers, and the prevalence of lesions (> 1.5 cm) was performed. Subsequently, the diagnostic performance of the univariate and combined variables for SVD and PVD was analyzed using binary logistic regression. The diagnostic value of the multivariate model for VDe was analyzed by ordinal logistic regression.

Results: (1) Serum ALP (p = 0.003) and hypersensitive C-reactive protein (hs-CRP, p = 0.001) concentrations increased as HAMD scores increased, and the prevalence of brain atrophy (p = 0.016) and lesions in the basal ganglia (p = 0.001) and parietal (p = 0.001), temporal (p = 0.002), and frontal lobes (p = 0.003) also increased, whereas the concentrations of hemoglobin (Hb, p = 0.003), cholinesterase (ChE, p = 0.001), and high-density lipoprotein cholesterol (HDL-C, p = 0.005) declined. Among these variables, hs-CRP (r = 0.218, p < 0.001) had a weak positively association with HAMD scores, and ChE (r = -0.226, p < 0.001) had a weak negative association. (2) The combination of Hb, hs-CRP, ChE, ALP, and HDL-C improved diagnostic performance for VDe [AUC = 0.775, 95% CI (0.706, 0.844), p < 0.001]. (3) Hb (OR = 0.986, p = 0.049), ChE (OR = 0.999, p = 0.020), ALP (OR = 1.017, p = 0.003), and basal ganglia lesions (OR = 2.197, p < 0.001) were important factors impacting VDe development. After adjusting for Hb, hs-CRP, ChE, HDL-C, lesions in the above mentioned four locations, sex, age and the prevalence of CSVD and brain atrophy, ALP [OR = 1.016, 95% CI (1.005, 1.027), p = 0.004] was independently associated with VDe.

Conclusion: Hb, hs-CRP, ChE, ALP, and HDL-C concentrations are potential blood markers of depression in CVD patients and, when combined, may improve diagnostic performance for VDe. Serum ALP was independently associated with VDe in patients with CVD.

Keywords: alkaline phosphatase; association; biomarkers; cerebrovascular disease; vascular depression.