Elevated monocyte-to-HDL cholesterol ratio predicts post-stroke depression

Abstract

Objectives: Inflammation plays an important role in the development of depression after stroke. Monocyte-to-HDL Cholesterol Ratio (MHR) recently emerged as a novel comprehensive inflammatory indicator in recent years. This study aimed to investigate whether there is a relationship between MHR levels and post-stroke depression (PSD).

Methods: From February 2019 to September 2021, patients with acute ischemic stroke (AIS) were recruited within 7 days post-stroke from the two centers and blood samples were collected after admission. The 17-item Hamilton Depression Scale (HAMD-17) was used to measure depressive symptoms at 3 months after stroke. Patients were given the DSM-V criteria for diagnosis of PSD.

Results: Of the 411 enrolled patients, 92 (22.38%) patients were diagnosed with PSD at 3-months follow-up. The results also showed significantly higher level of MHR in patients with depression [0.81 (IQR 0.67-0.87) vs. 0.61 (IQR 0.44-0.82), P < 0.001] at admission than patients without depression. Multivariate logistic regression revealed that MHR (OR 6.568, 95% CI: 2.123-14.565, P = 0.015) was an independent risk factor for the depression at 3 months after stroke. After adjustment for potential confounding factors, the odds ratio of PSD was 5.018 (95% CI: 1.694-14.867, P = 0.004) for the highest tertile of MHR compared with the lowest tertile. Based on the ROC curve, the optimal cut-off value of MHR as an indicator for prediction of PSD was projected to be 0.55, which yielded a sensitivity of 87% and a specificity of 68.3%, with the area under the curve at 0.660 (95% CI: 0.683-0.781; P = 0.003).

Conclusion: Elevated level of MHR was associated with PSD at 3 months, suggesting that MHR might be a useful Inflammatory markers to predict depression after stroke.

Keywords: Monocyte-to-HDL Cholesterol Ratio; depression; inflammation; monocyte; stroke.

FIGURE 1

Flowchart of participant selection.

FIGURE 2

The ROC curve analysis for MHR in predicting PSD. The cut-off value of MHR was 0.55, with a sensitivity of 87% and a specificity of 68.3%, AUC: 0.660 (95% CI: 0.683–0.781; P = 0.003). ROC, receiver operating characteristic; MHR, monocyte to high-density lipoprotein cholesterol ratio; PSD, post-stroke depression; AUC, area under the curve; CI, confidence interval.