Changes of serum uric acid and total bilirubin in elderly patients with major postischemic stroke depression

Abstract

BackgroundThis was a longitudinal study which investigated the relationship between serum uric acid (SUA) and total bilirubin (Tbil) upon admission in elderly stroke patients and the occurrence of postischemic stroke depression (IPSD) at 3, 6, and 9 months of post-stroke follow-up.Subjects and methodsData were analyzed for 525 acute ischemic stroke patients. Beck Depression Inventory (BDI) scores >17 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were used separately to screen and diagnose IPSD at 3, 6, and 9 months post-stroke. Once IPSD was diagnosed, follow-up activities were terminated.ResultsHigh levels of SUA (odds ratio [OR]=2.08, P<0.01) and Tbil (OR=2.31, P<0.01) in the first 3 months post-stroke and low levels of SUA (OR=2.05, P=0.03) and Tbil (OR=2.79, P<0.01) from 3 to 6 months post-stroke were identified as risk factors for major IPSD. At 3 months, patients with SUA levels ≥406.5 μmol/L (males with SUA levels of ≥409.5 μmol/L and females with SUA levels ≥385.5 μmol/L) and Tbil levels ≥23.65 μmol/L were more likely to develop major IPSD. At 6 months, both SUA (area under curve [AUC]=0.625, P=0.005, cutoff =194.0 μmol/L) and Tbil (AUC=0.681, P=0.004, cutoff =6.75 μmol/L) had minor diagnostic values (AUC<0.700), although SUA levels ≤214.5 μmol/L (AUC=0.756, P=0.001) in female patients had a good diagnostic value (AUC=0.722, P=0.006) for major IPSD. At 9 months, major IPSD showed no statistical relationship with either SUA (χ2=2.33, P=0.13) or Tbil (χ2=0.41, P=0.84).ConclusionHigher levels of SUA and Tbil on admission were closely related to the occurrence of major IPSD within 3 months of stroke. Lower levels of these two biomarkers on admission were characteristic for the occurrence of major IPSD between 3 and 6 months post-stroke, while 6 months after stroke, there was no relationship between major IPSD and these two biomarkers.

Lower Serum Uric Acid Is Associated With Post-Stroke Depression at Discharge

“…Previous study has reported the higher levels of SUA on admission was associated with the occurrence of 3-month major PSD, while lower level of SUA on admission was closely related to the occurrence of major PSD between 3-and 6month post-stroke. Six months after acute ischemic stroke, there was no relationship between major PSD and baseline SUA (15). The differences in time of assessment and diagnosis, subjects' samples, and psychiatric assessment methods could explain the discrepancies between our study and their findings.…”

“…In recent years, the interest of psychiatrist in the association between oxidative stress and depression has grown stronger and relevant studies have shown that the depression is accompanied by increased oxidative stress and decreased antioxidant defenses (24,25). Unlike previous studies, the present investigation focused on the occurrence of PSD at discharge and attempted to link this outcome with SUA levels on admission (15). Our study may provide an effective biomarker for psychiatrists to diagnose PSD at discharge.…”

“…effective predictor in the development of PSD (15). Individuals with lower baseline SUA levels may be more susceptible to oxidative damage in the brain, as a result of lower antioxidant defenses and larger oxygen consumption in brain.…”

“…A recent meta-analysis has shown that subjects with major depressive disorders (MDD) have levels of the antioxidate uric acid (UA) lower than healthy controls (14). Moreover, previous studies have shown that the lower SUA level is associated with both PSD and depression (9,15). However, the assessment on the association between SUA and PSD only aimed at 3-and 6-month outcomes.…”

Depression and Insomnia Are Closely Associated with Thyroid Hormone Levels in Chronic Hepatitis B

“…Because of the high metabolic and low antioxidant characteristics of the brain, oxidative and nitrosative stress pathways are considered the most crucial pathophysiological factors [23]. Bilirubin, as the final metabolite of hemoglobin, is a strong antioxidant, but also has neurotoxicity and can easily spread through the blood-brain barrier [24]. Unconjugated bilirubin has been proved to cause neurotoxicity and brain cell death [25].…”