Post-Stroke Depression in Patients with Large Spontaneous Intracerebral Hemorrhage.

Autor: Avadhani R; Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Thompson RE; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Carhuapoma L; Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA., Yenokyan G; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., McBee N; Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Lane K; Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Ostapkovich N; Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Stadnik A; Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA., Awad IA; Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA., Hanley DF; Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Ziai WC; Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: weziai@jhmi.edu.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2021 Nov; Vol. 30 (11), pp. 106082. Date of Electronic Publication: 2021 Sep 10.
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106082
Abstrakt: Objectives: To determine factors associated with post-stroke depression (PSD) and relationship between PSD and functional outcomes in spontaneous intracerebral hemorrhage (ICH) using prospective data from a large clinical trial.
Materials and Methods: MISTIE III, a randomized, multicenter, placebo-controlled trial, was conducted to determine if minimally invasive surgery with thrombolysis improves outcome compared to standard medical care. Our primary outcome was post-stroke depression at 180 days. Secondary outcomes were change in blinded assessment of modified Rankin Scale (mRS) from 30 to 180 days, and from 180 to 365 days. Logistic regression models were used to assess the relationship between PSD and outcomes.
Results: Among 379 survivors at day 180, 308 completed Center for Epidemiologic Studies Depression Scale, of which 111 (36%) were depressed. In the multivariable analysis, female sex (Adjusted Odds Ratio [AOR], 95% Confidence Interval [CI]: 1.93 [1.07-3.48]), Hispanic ethnicity (3.05 [1.19-7.85]), intraventricular hemorrhage (1.88 [1.02-3.45]), right-sided lesions (3.00 [1.43-6.29]), impaired mini mental state examination at day 30 (2.50 [1.13-5.54]), and not being at home at day 30 (3.17 [1.05-9.57]) were significantly associated with higher odds of PSD. Patients with PSD were significantly more likely to have unchanged or worsening mRS from day 30 to 180 (42.3% vs. 25.9%; p=0.004), but not from day 180 to 365.
Conclusions: We report high burden of PSD in patients with large volume ICH. Impaired cognition and not living at home may be more important than physical limitations in predicting PSD. Increased screening of high-risk post-stroke patients for depression, especially females and Hispanics may be warranted.
Competing Interests: Declaration of Competing Interest Ms. Avadhani, Dr. Thompson, Ms. Carhuapoma, Dr. Yenokyan, Ms. McBee, Ms. Lane, Ms. Ostapkovich, and Ms. Stadnik report no disclosures. Drs. Awad and Hanley were awarded significant research support for Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE) III by NIH/NINDS grant U01NS080824. Dr. Ziai is supported by grants R01NS102583, U01NS106513 and U01NS080824. Dr. Awad reports grants from NIH outside the submitted work. Dr. Hanley reports grants from NIH and personal fees from BrainScope, Neurotrope, Op2Lysis, and Portola Pharmaceuticals, outside the submitted work. Dr. Ziai is an associate editor for Neurocritical Care and an assistant editor for Stroke and has received consulting fees from Portola and data monitoring committee fees from C.R. Bard, Inc. outside the submitted work.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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