Relationship between serum neutrophil gelatinase-associated lipocalin levels and cognitive impairment, anxiety, and depressive symptoms in acute ischemic stroke

doi:10.5498/wjp.v14.i10.1467

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Psychiatry. Oct 19, 2024; 14(10): 1467-1473
Published online Oct 19, 2024. doi: 10.5498/wjp.v14.i10.1467

Relationship between serum neutrophil gelatinase-associated lipocalin levels and cognitive impairment, anxiety, and depressive symptoms in acute ischemic stroke

You-Quan Gu, Xuan Zhou, Li-He Yao, Qiang Wang, Chao-Ning Zhou, Zhao-Dong Liu

You-Quan Gu, Li-He Yao, Qiang Wang, Chao-Ning Zhou, Zhao-Dong Liu, Department of Neurology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China

Xuan Zhou, Department of Neurology, The First Clinical Medical College of Lanzhou University, Lanzhou 730099, Gansu Province, China

Author contributions: Gu YQ conceived the project; Zhou X, Yao LH, and Wang Q collected and analyzed the data; Gu YQ and Zhou CN wrote the first draft of the manuscript; Liu ZD provided expert suggestions and revised the manuscript. All authors contributed to the article and approved the submitted version.

Supported by Gansu Provincial Natural Science Foundation, No. 20JR10RA671; and The Fund of the First Hospital of Lanzhou University, No. ldyyyn2021-103.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Hospital of Lanzhou University, Approval No. LZ-009.

Informed consent statement: The patient/participant provided written informed consent to participate in this study. The publication of any potentially identifiable data included in this article has obtained the individual’s written informed consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding authors.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: You-Quan Gu, MM, Chief Physician, Department of Neurology, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou 730000, Gansu Province, China. guyq@lzu.edu.cn

Received: August 6, 2024
Revised: August 31, 2024
Accepted: September 14, 2024
Published online: October 19, 2024
Processing time: 72 Days and 0.6 Hours

Abstract

BACKGROUND

Acute ischemic stroke (AIS) is a significant global health issue with increasing incidence owing to aging populations and rising cardiovascular risk factors. In addition to physical impairments, AIS frequently leads to neuropsychiatric complications, such as cognitive impairment, anxiety, and depressive symptoms, which adversely affect patients’ quality of life and rehabilitation. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a potential biomarker for various conditions, including AIS. This study investigated the association between serum NGAL levels at admission and neuropsychiatric complications in patients with AIS.

AIM

To investigate the relationship between serum NGAL levels at admission and neuropsychiatric complications in patients with AIS.

METHODS

Between January 2022 and December 2023, 150 patients with AIS were enrolled. Serum NGAL levels were measured at admission using an enzyme-linked immunosorbent assay. Cognitive function was assessed using the Mini-Mental State Examination, while anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale at discharge. The relationship between serum NGAL levels and cognitive impairment, anxiety, and depressive symptoms was analyzed using multivariate logistic regression, adjusted for potential confounders of age, sex, body mass index, smoking status, hypertension, diabetes mellitus, dyslipidemia, previous stroke, and stroke severity.

RESULTS

The mean age of the participants was 65.4 ± 10.2 years, and 58% were males. Prevalence rates of cognitive impairment, anxiety, and depressive symptoms at discharge were 34.7%, 28.0%, and 32.0%, respectively. Serum NGAL levels were significantly higher in patients with cognitive impairment (median: 5.6 ng/mL vs 3.2 ng/mL, P < 0.001), anxiety (median: 5.1 ng/mL vs 3.5 ng/mL, P = 0.002), and depressive symptoms (median: 5.4 ng/mL vs 3.3 ng/mL, P < 0.001), compared to those without these conditions. Multivariate logistic regression analysis showed that higher serum NGAL levels at admission were independently associated with cognitive impairment [odds ratio (OR) = 1.42, 95% confidence interval (CI): 1.18-1.71, P < 0.001], anxiety (OR = 1.28, 95%CI: 1.09-1.51, P = 0.003), and depressive symptoms (OR = 1.39, 95%CI: 1.16-1.67, P < 0.001) after adjusting for potential confounders.

CONCLUSION

Elevated serum NGAL levels were independently associated with cognitive impairment, anxiety, and depressive symptoms in patients with AIS; and may function as potential biomarkers for patients at risk.

Keywords: Neutrophil gelatinase-associated lipocalin; Neuropsychiatric complications; Biomarker; Acute ischemic stroke; Cognitive impairment; Anxiety; Depressive symptoms

Core Tip: This study reveals the relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) levels at admission and neuropsychiatric complications, including cognitive impairment, anxiety, and depressive symptoms, in patients with acute ischemic stroke (AIS). The findings indicate that higher NGAL levels are significantly associated with these complications. NGAL can serve as a potential biomarker for early identification of patients with AIS at risk for neuropsychiatric issues, enabling timely interventions and improved outcomes. This study highlights NGAL’s multifaceted roles in AIS-related neuropsychiatric complications and its potential therapeutic implications.