Hormone, Antidiuretic

This study was a restrictive observation study from the Medical Information Mart for Intensive Care IV (MIMIC-IV version 0.4) database from 2008 to 2019 [24 ]. An individual who has finished the Collaborative Institutional Training Initiative examination (Certification number 35931520 for author Zhou) can access the database. This is a longitudinal, single-center database including 257,366 individuals and 196,527 adults, and 11,263 patients with sepsis (Defined by sepsis-3 criteria [1 (link)]). In our study, we extracted patients’ parameters containing age, gender, ethnic group, admission type, insurance condition, the first 24-h Sequential Organ Failure Assessment (SOFA) score, Simplified Acute Physiology Score II (SAPS) score, mean arterial blood pressure (MAP), heart rate, respiratory rate, temperature, SpO₂, total urine output during the first 24 h after ICU admission, lactate level, the use of vasopressors, weight, mechanical ventilation, renal replacement therapy (RRT), the stage of acute kidney injury (AKI), anamnesis (myocardial infarction, cancer, renal disease, cirrhosis and diabetes) and the type and volume of their fluid administration during the whole ICU stay. Vasopressors included norepinephrine, phenylephrine, epinephrine, vasopressin, dopamine, and dobutamine. For the antibiotics, Carbapenems (meropenem), Glycopeptide (vancomycin), β-lactams (ceftriaxone, cefotaxime, and cefepime), and Aminoglycosides (gentamicin and amikacin) were extracted into our analysis. In this study, types of administration for crystalloids and albumin including normal saline and lactated Ringer’s (LR) solution, while 5% and 25% HSA for colloids. The code of data extraction is available on Github (https://github.com/MIT-LCP/mimic-iv).
Adults patients (≥ 18 years) with sepsis and complete fluid administration records were screened in the analysis. The following exclusion criteria were used: (1) patients who have not received any crystalloids administration; (2) patients who received albumin longer than 24 h after the initiation of crystalloids administration or preceded the crystalloids. For patients who had ICU admission more than once, only data of the first ICU admission of the first hospital stay were included.

Venous blood samples were taking from all the 24 depressed and 66 randomly selected non-depressed individuals 6 to 8 weeks after delivery at 9–9:30 h. Blood samples were taken after 15-min rest. The samples were added to the EDTA-containing chilled plastic tubes. Then they were immediately kept at 4 °C within 30 min, and plasma separation was carried out. The samples were centrifuged at 3000 rpm for 10 min at 4 °C. The produced plasma was frozen at a temperature of − 80 °C until analysis. After transferring to the Endocrinology and Metabolism Laboratories of Shahid Beheshti University of Medical Sciences, Tehran/Iran, the plasma vasopressin level was measured by the ELISA method using Human Anti-Diuretic Hormone (ADH) ELISA kit (ZellBio GmbH, Ulm Germany) with a sensitivity of 0.5 ng/ml. In our study, plasma osmolality was not measured.
The relationship between plasma vasopressin levels and the EPDS score was assessed. Then the participating mothers were divided into depressed and non-depressed groups according to the EPDS score and confirmation by psychiatrist. Next, the mean plasma AVP level was compared between the two groups. Finally, a binary logistic regression analysis was carried out to further understand the association of the independent variables, including AVP and clinical-anamnestic factors with PPD. Odds ratio with 95% confidence interval was used.

The required sample size to study on pregnant women at 38 weeks of gestation was estimated to be 303 individuals (CI = 95%, P-value = 5%). For assessing the relationship between plasma vasopressin level and EPDS score at 6–8 weeks postpartum, the sample size was calculated to be 95 persons. All the 303 subjects were selected from among those who were referred to Urban and Rural Health Care Centers for prenatal care and were not depressed according to their EPDS score (< 13). They were first briefed about the study objectives and confidentiality of maternal and neonatal information, and then their informed consent was obtained.
The study inclusion criteria were singleton pregnancy, no systemic diseases such as lupus and diabetes mellitus, no pregnancy complications like diabetes, pre-eclampsia, etc., no previous history of psychological problems, Iranian nationality, no use of antidepressants, hormonal contraceptive pills, or sleeping pills within 2 weeks prior to venous blood sampling, good marital relationship with the spouse, no expressed significant economic problems, and no family history of depression or other mental illnesses. The study exclusion criteria were experiencing stressful conditions or using alcohol within 12 h before sampling, insufficient sleep and heavy physical activity the night before sampling, abnormal blood pressure during sampling or at postpartum period, instrumental vaginal delivery, congenital malformations of the newborn, and complications during childbirth (vaginal delivery or cesarean section) leading to treatments such as blood transfusion, resuscitation, hospitalization in the ICU or CCU, or transfer to the operating room. The mothers were controlled according to the routine prenatal care program until delivery. All participants (n = 303) were once again assessed with the Edinburgh Questionnaire during 6 to 8 weeks after delivery, and if they received a score of 13 or higher, they were referred to a psychiatrist to confirm their depression. Thirty-one of them scored 13 or more; of which, PPD of 29 subjects was confirmed by the psychiatrist. Sixteen non-depressed and five depressed subjects did not meet one of the inclusion criteria or were excluded from the study. Finally, the number of subjects in the depressed and non-depressed groups were 24 and 66, respectively.
Methods of data collection included observation, examination (weight, height, BMI, and other criteria in prenatal care forms such as blood pressure, fetal heart rate, fundal height, and warning signs during pregnancy), and patient interview. Gestational age was calculated from the first day of the last menstrual period (LMP), or the first trimester ultrasound (if uncertain about LMP). Weight, blood pressure, and heart rate of the fetus were measured by the same person using a digital scale, digital barometer, and fetal heart detector (Sonicaid), respectively.