Plasma fatty acid binding protein 4 and depression after acute ischemic stroke: a multicenter prospective study.

PURPOSE: Fatty acid-binding protein 4 (FABP4) has been reported to be involved in cerebral ischemia injury and neuropsychiatric disorders by modulating lipid metabolism and neuroinflammatory responses. But its effect on post-stroke depression (PSD) remains unclear. This study aimed to prospectively investigate the correlation between plasma FABP4 levels and PSD in a multicenter cohort study. METHODS: This study included 611 ischemic stroke patients from the Chinese Acute Ischemic Stroke Antihypertensive Trial. The 24-item Hamilton Depression Rating Scale was used to assess depression at 3 months after stroke, with PSD defined as a score of ≥8. Logistic regression models were performed to estimate the relationships between plasma FABP4 and the risk of PSD. A random forest regression model was used to incorporate multiple biomarkers and evaluate their predictive importance for PSD. RESULTS: The highest tertile of FABP4 levels was positively associated with an increased risk of PSD (multivariable-adjusted odds ratio, 1.80; 95% CI, 1.10-2.92) compared with the lowest tertile. Adding FABP4 to the conventional model improved the risk reclassification for PSD (net reclassification improvement: 27.6%, p < 0.001; integrated discrimination improvement: 1.1%, p = 0.013). The random forest regression model showed that FABP4 ranked among the top 5 most important predictors for PSD, with a predictive importance higher than high-sensitivity C-reactive protein, growth differentiation factor 15, homocysteine and other biomarkers. CONCLUSION: Elevated plasma FABP4 levels were independently associated with PSD after ischemic stroke, suggesting that FABP4 may serve as a potential prognostic biomarker to improve risk stratification for PSD.