Predictive value of CALLY index for depression after ischemic stroke

doi:10.11958/20241063

Abstract

Abstract:

Objective To investigate the predictive value of CALLY index for ischemic post-stroke depression (PSD). Methods The clinical data of 179 patients with ischemic stroke were included, and the demographic information, medical history, stroke severity and laboratory indicators at admission were collected. After 6 months of follow-up, all patients were assessed for depressive symptoms using the 17-item Hamilton Depression Scale (HAMD-17). Patients were divided into the PSD group (48 cases) and the non-PSD group (131 cases). Differences in clinical characteristics were compared between the PSD group and the non-PSD group. CALLY index was calculated from C-reactive protein (CRP), albumin (ALB) and lymphocyte counts. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of CALLY index to PSD. Spearman correlation analysis was used for the correlation between CALLY index and neurological and cognitive function in PSD patients. K-M curve and Cox regression were used for analyzing the influence of CALLY index on PSD. Results The CALLY index of 179 patients ranged from 0.54 to 1.79, with a median of 1.08. ROC curve analysis showed that the optimal critical value of CALLY index to predict PSD was 1.09, and the area under ROC curve was 0.757 (95%CI: 0.687-0.818). Compared with the non-PSD group, the proportion of females was higher in the PSD group, and the proportion of patients with hyperlipidemia was increased with shorter years of education. The serum C-reactive protein (CRP) was higher, and albumin (ALB) and CALLY index were lower (P<0.05). The K-M curve showed that the incidence of PSD was significantly higher in the low CALLY index group (CALLY≤1.08) than that in the higher CALLY index group (CALLY>1.08, 33.0% vs. 20.5%, Log rank χ²=8.553, P=0.004). Cox regression analysis showed that after adjusting for other covariates, the decreased CALLY index was an independent risk factor for PSD (HR=2.651, 95%CI: 1.269-5.540, P<0.05). Conclusion CALLY index has a certain predictive value for PSD in acute ischemic stroke patients, which is helpful for early identification and timely intervention to improve the prognosis of patients.

Key words: ischemic stroke, post-stroke depression, CALLY index, predictive model

CLC Number:

R743.3，R749.42

Figures/Tables 5

References 21

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变量		AUC		95%CI		最佳临界值
ALB		0.696		0.623~0.762		39.1 g/L
CRP		0.638		0.563~0.708		12.9 mg/L
LYM		0.568		0.492~0.641		2.3×10⁹/L
CALLY指数		0.757		0.687~0.818		1.09
变量	敏感度/%		特异度/%		约登指数		Z	P
ALB	31.25		96.18		0.274		4.420	<0.001
CRP	31.30		100.00		0.313		2.720	<0.001
LYM	83.33		35.88		0.192		1.523	0.123
CALLY指数	95.83		47.33		0.432		7.013	<0.001

变量		AUC		95%CI		最佳临界值
ALB		0.696		0.623~0.762		39.1 g/L
CRP		0.638		0.563~0.708		12.9 mg/L
LYM		0.568		0.492~0.641		2.3×10⁹/L
CALLY指数		0.757		0.687~0.818		1.09
变量	敏感度/%		特异度/%		约登指数		Z	P
ALB	31.25		96.18		0.274		4.420	<0.001
CRP	31.30		100.00		0.313		2.720	<0.001
LYM	83.33		35.88		0.192		1.523	0.123
CALLY指数	95.83		47.33		0.432		7.013	<0.001

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	受教育年限/年	高血压	冠心病	糖尿病	高脂血症	既往卒中史	吸烟
非PSD组	131	85/46	64.15±9.96	23.04±2.53	9（3，12）	57（43.51）	37（28.24）	30（22.90）	58（44.27）	16（12.21）	52（39.69）
PSD组	48	21/27	63.67±10.36	22.37±2.14	7（4，11）	31（64.58）	16（33.33）	12（25.00）	28（58.33）	10（20.83）	21（43.75）
χ²、t或Z		6.461^＊	0.283	1.632	2.367^＊＊	6.206^＊	0.557	0.185	6.242^＊	2.090	0.238
组别	饮酒	WBC/ （×10⁹/L）	Hb/ （g/L）	FPG/ （mmol/L）	CRP/ （mg/L）	ALB/ （g/L）	LYM/ （×10⁹/L）	CALLY 指数	NIHSS评分/分	MMSE 评分/分	mRS 评分/分
非PSD组	49（37.40）	12.8±3.4	180.5±26.8	6.01±1.13	8.6±2.4	47.63±5.45	2.01±0.62	1.16±0.34	7（5，11）	26（25，28）	2（1，4）
PSD组	19（39.58）	13.5±2.7	172.3±24.1	5.89±1.02	10.5±3.7	42.51±6.72	1.86±0.46	0.86±0.23	10（6，15）	22（16，26）	3（2，4）
χ²、t或Z	0.070	1.285	1.861	0.645	8.242^＊＊	5.219^＊＊	1.528	5.653^＊＊	2.846^＊＊	5.179^＊＊	1.948^＊

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	受教育年限/年	高血压	冠心病	糖尿病	高脂血症	既往卒中史	吸烟
非PSD组	131	85/46	64.15±9.96	23.04±2.53	9（3，12）	57（43.51）	37（28.24）	30（22.90）	58（44.27）	16（12.21）	52（39.69）
PSD组	48	21/27	63.67±10.36	22.37±2.14	7（4，11）	31（64.58）	16（33.33）	12（25.00）	28（58.33）	10（20.83）	21（43.75）
χ²、t或Z		6.461^＊	0.283	1.632	2.367^＊＊	6.206^＊	0.557	0.185	6.242^＊	2.090	0.238
组别	饮酒	WBC/ （×10⁹/L）	Hb/ （g/L）	FPG/ （mmol/L）	CRP/ （mg/L）	ALB/ （g/L）	LYM/ （×10⁹/L）	CALLY 指数	NIHSS评分/分	MMSE 评分/分	mRS 评分/分
非PSD组	49（37.40）	12.8±3.4	180.5±26.8	6.01±1.13	8.6±2.4	47.63±5.45	2.01±0.62	1.16±0.34	7（5，11）	26（25，28）	2（1，4）
PSD组	19（39.58）	13.5±2.7	172.3±24.1	5.89±1.02	10.5±3.7	42.51±6.72	1.86±0.46	0.86±0.23	10（6，15）	22（16，26）	3（2，4）
χ²、t或Z	0.070	1.285	1.861	0.645	8.242^＊＊	5.219^＊＊	1.528	5.653^＊＊	2.846^＊＊	5.179^＊＊	1.948^＊

指标	β	SE	Wald χ²	P	HR（95%CI）
未校正
CALLY指数	1.214	0.541	5.036	0.025	3.367（1.166~9.722）
校正后
CALLY指数	0.975	0.376	6.724	0.010	2.651（1.269~5.540）
性别	0.684	0.325	4.429	0.035	1.982（1.048~3.747）
年龄	0.575	0.326	3.111	0.078	1.777（0.938~3.367）
受教育年限	0.863	0.610	2.002	0.157	2.370（0.717~7.835）
高血压	0.968	0.336	8.300	0.004	2.633（1.363~5.086）
卒中史	0.382	0.274	1.944	0.163	1.465（0.856~2.057）
NIHSS评分	1.236	0.428	8.340	0.004	3.442（1.488~7.964）
mRS评分	1.057	0.469	5.079	0.024	2.878（1.148~7.216）
MMSE评分	-0.634	0.217	8.536	0.003	0.530（0.347~0.812）