Association of hepatorenal function biomarkers with depression risk in geriatric psychiatry inpatient: a hospital-based cross-sectional study

BMC Geriatr. 2025 Oct 31;25(1):829. doi: 10.1186/s12877-025-06536-x.

ABSTRACT

BACKGROUND: Emerging evidences have suggested a potential link between hepatorenal dysfunction and depression. However, the association between hepatorenal function biomarkers and geriatric depression remains unclear. This study aimed to evaluate the contribution of hepatorenal function biomarkers to depression risk in elderly psychiatric inpatients and identify potential predictive biomarkers for geriatric depression.

METHODS: This cross-sectional study analyzed electronic medical records of geriatric psychiatric inpatients (July 2021-December 2024) from a hospital in Eastern China. Multivariable logistic regression models were applied to examine associations between alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio, blood urea nitrogen (BUN), BUN/creatinine (Cr) ratio and depression risk, with restricted cubic spline models assessing dose-response relationships. Progressive adjustments included demographic characteristics, metabolic indicators, inflammatory markers, and comorbidities. Subgroup analyses with interaction tests evaluated heterogeneity across predefined subgroups.

RESULTS: Analysis of 1,783 participants (688 with depression) revealed that depressed patients exhibited a higher ALT/AST ratio (0.9 vs. 0.8; P < 0.001) with lower BUN (5.4 vs. 6.5 mmol/L; P < 0.001) and BUN/Cr ratio (19.4 vs. 21.2; P < 0.001). Adjusted models demonstrated that each 1-unit increase in ALT/AST ratio was associated with a 106% higher risk of depression (OR = 2.06, 95% CI: 1.41-3.01; P < 0.001), whereas each 1-unit increase in BUN and BUN/Cr ratio corresponded to 16% (OR = 0.84, 95% CI: 0.79-0.89) and 4% (OR = 0.96, 95% CI: 0.94-0.98) decreased risks, respectively (P < 0.001). Restricted cubic spline analyses identified linear dose-response relationships: ALT/AST ratio positively correlated with depression risk (P < 0.001), while lower levels of BUN (P < 0.001) and BUN/Cr ratio (P < 0.001) inversely associated with depression risk, with no significant heterogeneity across subgroups (interaction P > 0.05).

CONCLUSION: Hepatorenal function biomarkers (ALT/AST ratio, BUN, BUN/Cr ratio) demonstrate independent associations with geriatric depression risk, suggesting potential involvement of liver-brain and kidney-brain axis in depressive pathophysiology. We recommend incorporating these biomarkers into depression risk stratification protocols for elderly inpatients and propose novel research avenues to elucidate multi-organ crosstalk mechanisms.

PMID:41174538 | DOI:10.1186/s12877-025-06536-x