Abstract 11278: Association of Homocysteine and C-Reactive Protein With Post-Stroke Depression: A Meta Analysis and Meta Regression

Abstract

Introduction: Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke with a high incidence of 31% and that is associated with poor functional outcomes and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD. Hypothesis: To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without depression. Methods: We systematically searched all electronic databases from inception until May 30th 2022 comparing baseline CRP and Hcy. Results: A total of 12 studies with 3,154 Patients were included in this analysis. The mean age of the overall cohort was 64.8 years with PSD patients appearing to be older than non-PSD patients (mean 67.3 years vs 63.8 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (48.9% vs 40.7%). PSD patients were more likely to be widowed (18% vs 7.25%) and had a family history of psychiatric disorder (10.4% vs 4.4%) compared to non-PSD patients. Patients with PSD had higher levels of baseline CRP [SMD 0.86, (95% CI 0.65 to 1.08), p<0.001; I2=87%] and Hcy PSD [SMD 1.12, (95% CI 0.57 to 1.67), p<0.001; I2=96%] compared to patients without PSD. Meta-regression was performed using covariates including age, female gender, hypertension, diabetes mellitus, CAD, NIHSS, widowhood and family history of psychiatric disorder. Diabetes mellitus appeared to be the only significant effect modifier (coefficient 0.23, p=0.01) for the association between baseline CRP and PSD. Conclusions: Elevated baseline levels of CRP and Hcy were significantly higher in patients that developed PSD, suggesting that both could play a role in the pathophysiology of PSD and as a potential biomarker for diagnosing risk of depression