Depression Screening And Coronary Artery Bypass Graft Surgery Patients And The Correlation Of Serum Inflammatory Factors Research

Objectives:Depression is frequently observed in patients with coronary heart disease (CHD) and represents a significant risk factor for major cardiovascular events. This study aimed to estimate the prevalence of preoperative depressive disorder in patients undergoing coronary bypass surgery and determine risk factors.Methods:This study was designed as a prospective observational study. From March1,2010to September30,2010, we collected the clinical information of258consecutive patients undergoing first-time elective coronary bypass surgery in Fuwai Hospital. The exclusion criteria included the following subjects:(1) less than18years of age,(2) subjects with previous CABG,(3) a language barrier preventing questionnaire completion,(4) history of mental illness, and (5) died during hospitalization. At last,232participants completed the whole study. Each participant completed the baseline evaluation at least3days before CABG including depressive symptoms and collection of fasting blood samples. In this study, depression was elevated by the Patient Health Questionnaire scale (PHQ-9). Based on the PHQ-9scores, depression was divided into severe depression (PHQ-9Score≥10points), mild depression (PHQ-9score:4to9) and no depression (PHQ-9score<4). Logistic regression model was used to analysis the potential risk factors of preoperative major depressive disorder in patients undergoing bypass surgery. This study was approved by the local ethics committee, and all participants of the study were voluntary and provided written informed consent.Results:The mean age of patients was60.8±8.6years and18.5%were female. Of the study patients,36.6%met the criteria for depressive disorders,42(18.1%) for major depression,43(18.5%) for moderate depression. Major depressive disorder was strongly and independently associated with female and the circulating levels of the high sensitivity c-reactive protein (female:OR2.99,95%CI1.06-8.38; hsCRP:OR1.15,95%CI1.06-1.26) in these patients. Conclusions:This study showed there was high prevalence of depressive disorder in CABG patients before surgery. Female and levels of high sensitivity c-reactive protein were independently associated with the high risk of preoperative major depression among patients undergoing CABG. Objectives:Depression is a common feature observed in patients with coronary heart disease, and is associated with inflammatory response. However, the effects of blood inflammatory proteins on the risk for depression remains unclear in patients undergoing coronary artery bypass grafting (CABG). This study aims to explore the relationship between the preoperative levels of blood inflammation proteins and post-CABG depressive disorders.Methods:From March1,2010to September30,2010, the conclutive patients undergoing coronary bypass surgery in Fuwai Hospital were enrolled in our study. The blood samples of these patients were collected at least3days before surgery and we measured the serum levels of inflammation proteins such as high sensitive C-reactive protein (hsCRP), intercellular adhesion molecule1(ICAM-1), interleukin-1β (IL-1β) and interferon-y (IFN-y). We access the depressive disorders by the means of the Patient Health Questionnaire scale (PHQ-9>10) among these CABG patents preoperatively as well as1month and6month after the operation via telephone contact. As PHQ-9score results for the endpoint, multivariable logistic regression was used to determine whether the high serum levels of inflammation proteins preoperatively played an important role in the occurrence of postoperative depressive disorders in CABG patients. The predictive function of the depressive related inflammatory markers was assessed by area under ROC (AUC).Results:There were258patients undergoing CABG included at baseline and a total of232patients completed the follow up at last,2patients were lost for the reason of death during hospitalization. Of all the study population, the mean age was (60.8±8.6) years and18.5%were female (43/232). Depressive disorders were found in18.1%(42/232),14.7%(34/232) of patients in1month follow up group and18.1%(42/232) in6month follow up group. The incidence of depressive disorders among the above two groups was statistically significant (P<0.001). Depressive symptoms were more prevalent in women compared with men (6month follow up results:20.9%versus17.5%, P=0.594). And the serum level of hsCRP was significantly higher in postoperative depression patients than those patients without depressive symptoms (4.89mg/1:2.97mg/l, P=0.015). Postoperative depression was only associated with hsCRP (OR1.15,95%CI:1.05,1.25) in these patients. Likewise, elevated hsCRP levels (OR1.16,95%CI1.05,1.28) remained associated with future depression during a follow-up questionnaire, and were independent of post-operative medications and major adverse cardiovascular events. While the other inflammation factors as intercellular adhesion molecule1(ICAM-1), interleukin-1β(IL-1β) and interferon-y (IFN-y) were not associated with postoperative depression (ICAM-1:OR1.00,95%CI1.00-1.00; IL-1β:OR0.98,95%CI0.92-1.04; IFN-y:OR0.9895%CI0.93-1.04).Conclusions:The elevated serum hsCRP was an independent predictor for depression in CABG patients at6months after surgery.