Higher Concentration of Adrenocorticotropic Hormone Predicts Post-Stroke Depression

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2022 Apr 12

PMID 35411137

Authors

Yanyan Wang

He Wang

Wenzhe Sun

Jinfeng Miao

Wenwen Liang

Xiuli Qiu

Yan Lan

Chensheng Pan

Guo Li

Xin Zhao

Zhou Zhu

Suiqiang Zhu

Affiliations

Soon will be listed here.

Abstract

Background: Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, seriously affecting the quality of survivors' life. As one of the important causes of PSD, neuroendocrine mechanism has been widely studied in recent years. The main objective of this study was to investigate the relationship between adrenocorticotropic hormone (ACTH) on admission and PSD at 3 months.

Methods: This is a hospital-based prospective cohort study, which was conducted at three independent hospitals (Tongji Hospital, Wuhan First Hospital and Wuhan Central Hospital) between August 2018 and June 2019. A total of 768 ischemic stroke patients were finally eligible for analysis and categorized into equal tertiles according to the distribution of ACTH and the number of patients. The -test, Mann-Whitney -test and Kruskal-Wallis test were used to check for statistical significance. And restricted cubic spline (RCS) regression model was used to explore the non-linear relationship between continuous ACTH levels and PSD at 3 months.

Results: The optimal cut-off points of ACTH were as follows: (T1) 0.32-20.55 pg/mL, (T2) 20.56-39.79 pg/mL, (T3) 39.80-143.40 pg/mL. A total of 305 patients (39.7%) were diagnosed as PSD at 3 months follow-up. Significant differences were found between the PSD and non-PSD groups in ACTH concentration (P = 0.001). After adjustment for all conventional confounders, the odds ratios of PSD were 1.735 (95% CI = 1.176-2.560, P = 0.005) for the highest tertile of ACTH and 1.496 (95% CI = 1.019-2.194, P = 0.040) for the middle tertile of ACTH, as compared with the lowest tertile. In multiple-adjusted RCS regression, continuous ACTH showed saturation effect relation with PSD risk after 31.02 pg/mL (P for nonlinear = 0.0143).

Conclusion: Higher ACTH level on admission is a significant and independent biomarker to predict the development of PSD at 3 months follow-up. Besides, saturation effect was revealed even if the underlying mechanism is unclear. For stroke patients, doctors should pay attention to the baseline ACTH for screening high-risk PSD in clinical practice.

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