TY - JOUR
T1 - Post-Stroke Depression in Patients with Large Spontaneous Intracerebral Hemorrhage
AU - Avadhani, Radhika
AU - Thompson, Richard E.
AU - Carhuapoma, Lourdes
AU - Yenokyan, Gayane
AU - McBee, Nichol
AU - Lane, Karen
AU - Ostapkovich, Noeleen
AU - Stadnik, Agnieszka
AU - Awad, Issam A.
AU - Hanley, Daniel F.
AU - Ziai, Wendy C.
N1 - Funding Information:
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 .
Funding Information:
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.
Funding Information:
MISTIE III was supported by a grant from the National Institutes of Health / National Institute of Neurological Disorders and Stroke ( U01NS080824 ) and materials grants from Genentech.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
KW - Clinical outcomes
KW - Cognitive impairment
KW - Intracerebral hemorrhage
KW - Post-stroke depression
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U2 - 10.1016/j.jstrokecerebrovasdis.2021.106082
DO - 10.1016/j.jstrokecerebrovasdis.2021.106082
M3 - Article
C2 - 34517296
AN - SCOPUS:85115745349
SN - 1052-3057
VL - 30
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 11
M1 - 106082
ER -