Abstract
Association between sarcopenia, as evaluated by grip strength (GS) and skeletal muscle mass (SMM), and depression, as evaluated by Beck Depression Inventory-2nd edition (BDI-II) in chronic liver diseases (CLDs, n = 414, average age = 61.5 years), was investigated. Study subjects were classified into four groups: Group A (n = 60), lower GS and lower SMM (sarcopenia); group B (n = 44), lower GS and higher SMM; group C (n = 100), higher GS and lower SMM; group D (n = 210), higher GS and higher SMM. Factors associated with BDI-II score ≥11 were examined. BDI-II score 0–10 (normal) was found in 284 (68.6%), 11–16 (minimal) in 76 (18.4%), 17–20 (mild) in 24 (5.8%), 21–30 (moderate) in 15 (3.6%), and ≥31 (severe) in 15 (3.6%). The average ± standard deviation BDI-II score in liver cirrhosis (LC) patients (10.2 ± 9.6, n = 152) was significantly higher than that in non-LC patients (7.4 ± 7.2, n = 262) (p = 0.0058). Univariate analysis identified three factors to be significantly associated with BDI-I score ≥11: Our classification (groups of A, B, C, and D) (p = 0.0259), serum albumin (p = 0.0445), and the presence of LC (p = 0.0157). Multivariate analysis revealed that only group A (p = 0.0074, group D as a reference) was significant. In conclusion, sarcopenia can be an independent predictor for depression in CLDs.
Highlights
Depression is common in patients with chronic liver diseases (CLDs) [1,2,3,4,5,6,7,8]
Among groups of A (n = 60), B (n = 44), C (n = 100), and D (n = 210), overall differences were identified with statistical significance in terms of age (p < 0.0001), gender (p = 0.0019), presence of liver cirrhosis (LC) (p = 0.0007), body mass index (BMI) (p < 0.0001), serum albumin (p < 0.0001), prothrombin time (p = 0.0004), platelet count (p = 0.0013), total cholesterol (p = 0.0085), estimated glomerular filtration rate (p = 0.0495), and Beck Depression Inventory-2nd edition (BDI-II) score (p < 0.0001)
Regarding reasons why the high prevalence of CLD patients with depression is observed, the following aspects should be considered: (a) The long-term suffering caused by CLD itself, worry about disease progression and fear of infection; (b) social pressure for studying and working; and (c) economic pressure including high cost for expected medical treatments such as antiviral therapies [5]
Summary
Depression is common in patients with chronic liver diseases (CLDs) [1,2,3,4,5,6,7,8]. Impaired quality of life (QOL) and increasing health care costs have been reported for CLD patients with depression [4,10]. In Japan, 10–70% of CLD patients have sarcopenia This prompted the Japan Society of Hepatology (JSH) to create guidelines for the diagnosis of sarcopenia in liver disease (first edition) in 2016 [14,18]. We sought to investigate whether an independent association exists between sarcopenia and depression, as evaluated by BDI-II in patients with CLDs
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