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.

中文翻译：

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大量自发性脑出血患者的卒中后抑郁

目标

使用来自大型临床试验的前瞻性数据确定与卒中后抑郁 (PSD) 相关的因素以及 PSD 与自发性脑出血 (ICH) 功能结果之间的关系。

材料和方法

MISTIE III 是一项随机、多中心、安慰剂对照试验，旨在确定与标准医疗护理相比，溶栓微创手术是否能改善结果。我们的主要结果是 180 天时的卒中后抑郁。次要结果是改良兰金量表 (mRS) 盲法评估从 30 天到 180 天和从 180 天到 365 天的变化。Logistic 回归模型用于评估 PSD 与结果之间的关系。

结果

在第 180 天的 379 名幸存者中，308 人完成了流行病学研究中心抑郁量表，其中 111 人 (36%) 患有抑郁症。在多变量分析中，女性（调整后的优势比 [AOR]，95% 置信区间 [CI]：1.93 [1.07-3.48]），西班牙裔（3.05 [1.19-7.85]），脑室内出血（1.88 [1.02-3.45]） ])、右侧病变 (3.00 [1.43-6.29])、第 30 天的小型精神状态检查受损 (2.50 [1.13-5.54]) 以及第 30 天不在家 (3.17 [1.05-9.57])与较高的 PSD 几率显着相关。从第 30 天到第 180 天，PSD 患者的 mRS 无变化或恶化的可能性明显更大（42.3% 对 25.9%；p=0.004），但从第 180 天到第 365 天则不然。

结论

我们报告了大量 ICH 患者的高 PSD 负担。在预测 PSD 时，认知受损和不在家生活可能比身体限制更重要。可能有必要加强对高危卒中后抑郁症患者的筛查，尤其是女性和西班牙裔患者。