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The association between serum albumin and depression in chronic liver disease may differ by liver histology
Junyan Cao1, Weihong Qiu2, Yong Yu2
1Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.
Insights
Lower serum albumin levels correlate with increased depression symptoms in chronic liver disease (CLD) patients. This finding highlights serum albumin as a potential biomarker for monitoring depression in CLD management.
Area of Science:
- Hepatology
- Psychiatry
- Biomarkers
Background:
- Conflicting results exist on the association between chronic liver disease (CLD) and depression.
- Underlying biological mechanisms linking CLD and depression require further investigation.
- Identifying a biological marker is crucial for understanding depression's impact on CLD management.
Purpose of the Study:
- To explore the association between serum albumin and depression in CLD patients.
- To determine if this association varies across different liver histological stages.
Main Methods:
- Utilized data from 627 participants with CLD from the US National Health and Nutrition Examination Survey (2017-2018).
- Assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9).
- Employed multivariate linear regression and stratified analyses based on liver histology (controlled attenuation parameter and liver stiffness measurement).
Main Results:
- A significant inverse association was found between serum albumin levels and PHQ-9 depression scores (β = -1.113, P = 0.0221).
- This inverse association persisted in females, patients with controlled attenuation parameter < 274 dB/m, and those with liver stiffness measurement ≥ 8.2 kPa.
- The association was notably stronger in patients with higher serum albumin (> 3.4 g/dL) and significant liver stiffness (≥ 8.2 kPa).
Conclusions:
- Serum albumin is inversely associated with depression in CLD patients.
- The strength of this association is influenced by liver histological changes.
- Serum albumin may serve as a valuable warning marker for depressive symptoms in CLD, guiding intervention strategies.
Background:
There are conflicting results regarding the association between chronic liver disease (CLD) and depression and the underlying biological mechanisms are lack of investigation. To address the impact of depression and its effects on the management of CLD, its biological marker is critical to be identified. The present study explored the association between serum albumin and depression in CLD patients and whether the association varied in different liver histological stages.
Methods:
Based on the United States National Health and Nutrition Examination Survey 2017-2018, the data of serum albumin and depressive symptoms from 627 participants with CLD were used. Depression symptoms were assessed with the nine-item Patient Health Questionnaire (PHQ-9). We used multivariate linear regression to evaluate the association between serum albumin and PHQ-9 scores. Stratified analysis was performed according to the liver histology examined by vibration controlled transient elastography.
Results:
Serum albumin level was inversely associated with PHQ-9 scores in the multivariate regression model after adjusting for mainly potential confounders (β = - 1.113, 95% CI: - 2.065 to - 0.162, P = 0.0221). In the subgroup analysis stratified by gender, controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), the inverse association remained significant in female (β = - 2.002, 95% CI: - 3.515 to - 0.489, P = 0.0100), patients with CAP < 274 dB/m (β = - 2.215, 95% CI: - 3.621 to - 0.808, P = 0.0023) and patients with LSM ≥8.2 kPa (β = - 4.074, 95% CI: - 6.237 to - 1.911, P = 0.0003). Moreover, the association was much stronger when the serum albumin was higher than 3.4 g/dL among patients with LSM ≥8.2 kPa (β = - 4.835, 95% CI: - 7.137 to - 2.533, P < 0.0001).
Conclusion:
Our study revealed an inverse association between serum albumin and depression in CLD patients and this association differed according to liver histological changes. Serum albumin could be a warning marker for depressive symptoms in CLD patients. It is essential for taking corresponding intervention strategies.
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