AB0982 SERUM ALBUMIN LEVELS AND DEPRESSION IN JSLE
Authors: S. Ganhão, B. Silva, F. Aguiar, M. Rodrigues, M. Figueiredo-Braga, I. Brito
Journal: Annals of the Rheumatic Diseases (2020)

Background: Albumin is a negative acute phase response protein synthesized in the liver, being an important marker of inflammation. Under inflammatory conditions, the transcapillary escape rate of albumin may increase, leading to hypoalbuminaemia. Systemic lupus erythematosus (SLE) is a chronic condition involving multiple organ systems, inducing functional disability and psychological burden responsible for noteworthy depressive symptoms 1 . Depression may be related with psychosocial, environmental and biological factors, disease activity and its severity, age and sex 2 . Several studies show that immune activation and increased concentrations of positive and decreased concentrations of negative acute phase proteins are involved in the pathogenesis of depression 3 . As albumin has the capacity to bind homocysteine, lowered serum albumin levels leads to hyperhomocysteinemia, a well-known risk factor for depression. Moreover, hypoalbuminaemia decrease the availability of tryptophan, an essential amino acid from which the neurotransmitter serotonin is derived, and induce oxidative stress, which further decreases antioxidant levels in people with depression. Objectives: To assess the association between serum albumin levels and depressive symptoms in juvenile-onset SLE (jSLE) patients. Methods: A cross-sectional sample of jSLE patients, currently aged ≥ 16 years, completed a psychosocial assessment including quality of life (SF-36) anxiety and depressive symptoms (HADS) and cognitive assessment (MMSE), between October 2018- May 2019. Local Ethics Committee approved the study. All patients fulfilled both 2012 and 2019 EULAR/ACR classification criteria for SLE. Juvenile-onset was defined as age at diagnosis &lt;18 years. Demographics and clinical characteristics were collected. Statistical analysis was performed with SPSS®. Variables were compared with spearman correlations tests. Results: 30 jSLE patients were included (90%female) in the study, with median (min-max) age of 21 (16-35) years, with mean (SD) age of diagnosis of 15.8 ± 2.1. Median albumin serum level was 41.7 (16.7-46.3) g/dL. Psychosocial assessment revealed a mean (SD) score in HADS - Depression of 3.9 (3.3), HADS - Anxiety of 9 (4.3), MMSE of 27.7 (1.8), Physical health SF-36 of 66.8 (9.9) and Mental health SF-36 of 68.9 (17.5). 23.3 % jSLE showed mild cognitive impairment, 63.3% anxiety and 13.3% depression. We observed significant inverse linear relationships between serum albumin levels and depressive symptoms score (p=0.042, ρ=-0.380) and with anxiety symptoms score ((p=0.029, ρ=-0.406). No significant correlations were detected between albumin serum concentrations and cognitive assessment. Conclusion: Our findings are consistent with studies previously reporting the potentially protective effect of high serum albumin levels on mental health in different populations. A possible inflammation related aetiology for depression in jSLE patients is highlighted, further explained through the protective roles played by albumin in inflammation, infection, and oxidative damage. References: [1]Zhang, L. et al. Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis. BMC Psychiatry 17, 70 (2017) [2]Figueiredo-Braga M et al. Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors. Medicine (Baltimore). 2018;97(28) [3]Livia Ambrus &amp; Sofie Westling. Inverse association between serum albumin and depressive symptoms among drug-free individuals with a recent suicide attempt, Nordic Journal of Psychiatry, 73:4-5, 229-232 Disclosure of Interests: None declared