Nutritional status and depressive symptoms in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization: association with inflammation

Abstract

Purpose: To evaluate whether there are relationships among nutritional status, depressive symptoms and inflammation in patients with hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolization (TACE).Methods: One hundred thirty patients with HCC undergoing TACE were recruited for this study. Nutritional status and depressive symptoms were assessed after TACE by using questionnaires derived from the Patient-Generated Subjective Global Assessment (PG-SGA) and Hospital Anxiety Depression Scale depression subscale (HADS-D), respectively. Systemic inflammation was evaluated using the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).Results: A total of 89.2% of the patients were malnourished, and 58.5% of the patients presented with depressive symptoms. Poor nutritional status was significantly correlated with depressive symptoms (r=0.651, p<0.001), whereas no significant correlations were found between nutritional status and NLR (r=0.085, p=0.066), PLR (r=0.162, p=0.066), or SII (r=0.130, p=0.140). Depression was significantly correlated with PLR (r=0.294, p=0.001) and SII (r=0.197, p=0.024), but there was no correlation between depressive symptoms and NLR (p >0.05). A multiple linear regression model showed that the PG-SGA score (β=0.469 (95% CI: 0.351-0.586), p<0.01) was independently associated with depression symptoms, but there was no significant association between PLR and depression (β=0.003 (95% CI: -0.002-0.007)), p=0.230). There was no significant interaction effect of PG-SGA × PLR on depression (β=0.000 (95% CI: -0.001-0.001), p=0.596). A similar multiple linear regression model indicated no independent effect of a SII or PG-SGA × SII interaction on depression (β=0.000 (95% CI: -0.001-0.001), p=0.926, β = 0.000 (95% CI: 0.000-0.000), p=0.513), but PG-SGA was associated with depression (β=0.472 (95% CI: 0.353-0.591), p＜0.001).Conclusion: Depression was significantly correlated with nutrition, PLR and SII, although the potential mechanism underlying the correlation between nutritional status and depression is not clearly related to inflammation.