Depression severity as a predictor of cardiovascular-kidney-metabolic syndrome progression and mortality: Results...

Depression is a common mental disorder linked to adverse clinical outcomes; however, its impact on the progression and prognosis of cardiovascular-kidney-metabolic (CKM) syndrome remains unclear. This study aimed to investigate whether higher depression severity is associated with an increased risk of CKM progression and to evaluate its prognostic significance for all-cause mortality.

We analyzed data from two large, nationally representative cohorts: the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable logistic regression and Cox proportional hazards models were employed to examine the associations between depression scores, CKM progression and mortality. Restricted cubic spline and Receiver operating characteristic analyses explored nonlinear relationships and predictive performance.

A total of 8571 NHANES participants and 7635 CHARLS participants were included in this study. Each 1-point increase in depression score correlated with a 7 % elevated risk of advanced CKM stage in both cohorts (adjusted OR = 1.07, 95 % CI: 1.06-1.09 for NHANES; OR = 1.07, 1.05-1.08 for CHARLS). Severe depression conferred the highest risk (NHANES: OR = 3.58, 2.04-6.30; CHARLS: OR = 3.06, 2.38-3.93). Depression scores predicted mortality, with HRs of 1.04 (1.02-1.05) per PHQ-9 point and 1.02 (1.00-1.03) per CES-D-10 point. Nonlinear (NHANES) and linear (CHARLS) trends were observed in RCS analyses. ROC curves demonstrated moderate predictive accuracy (AUC: 0.615 for CES-D-10; 0.580 for PHQ-9).

Higher depression severity is independently associated with CKM progression and increased mortality risk, underscoring its clinical utility for risk stratification. Integration of depression screening into CKM management may enhance early intervention and improve outcomes.