Association between depressive symptoms and mortality in patients with Cardiovascular-Kidney-Metabolic syndrome: The mediating role of inflammatory biomarkers

Abstract

Background: The objective of this investigation was to explore the correlation between depressive symptoms and mortality in individuals with different stages of Cardiovascular-Kidney-Metabolic syndrome, and to examine how inflammatory markers mediate this association.

Methods: The study included 12,314 participants derived from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. The association between depressive symptoms and mortality was examined across different stages of CKM using weight-based Cox regression analysis and restricted cubic spline (RCS) regression. A mediation analysis was conducted to assess effects of inflammatory markers on this correlation.

Results: After fully adjusting for potential confounders, participants with moderate to severe depression, compared to those with no depression, were correlated with higher mortality, including CKM stage 1 (hazard ratio[HR], 2.20 [95 % CI, 1.33, 3.64]), CKM stage 2 (HR, 1.75 [95 % CI, 1.18, 2.60]), and CKM stage 3 (HR, 2.34 [95 % CI, 1.12, 4.87]). In CKM stage 4, a higher PHQ-9 score (≥10) was not significantly linked to higher mortality (HR, 1.07 [95 % CI, 0.69, 1.64]). A positive linear correlation between the PHQ-9 score and all-cause mortality was revealed by the RCS regression analyses. The systemic inflammation response index (SIRI) and neutrophil count accounted for 12.0 % and 6.0 %, respectively, of the associations between depressive symptoms and mortality.

Conclusion: In this cohort study, depressive symptoms were significantly correlated with increased all-cause mortality among participants with CKM stages 1 to 3. Therefore, enhancing mental health monitoring and intervention can improve the long-term survival of individuals with CKM stages 1 to 3.

Keywords: Cardiovascular-Kidney-Metabolic syndrome; Depressive symptoms; Inflammatory markers.