Developing and Validating an Individualized Clinical Prediction Model to Forecast Psychotic Recurrence in Acute and Transient Psychotic Disorders: Electronic Health Record Cohort Study
| Autor: | Pierluigi Politi, Luisa Bernardinelli, Sergio Merlino, Teresa Fazia, Grazia Rutigliano, Stefano Damiani, Paolo Fusar-Poli, Carlo Berzuini |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Risk Pediatrics medicine.medical_specialty 03 medical and health sciences 0302 clinical medicine Lasso (statistics) Recurrence Models London medicine Electronic Health Records Humans psychosis Retrospective Studies validation Models Statistical Proportional hazards model business.industry Brief psychotic disorder Retrospective cohort study Middle Aged Statistical Prognosis medicine.disease Missing data brief psychotic disorder Regression 030227 psychiatry schizophrenia Psychiatry and Mental health Psychotic Disorders Schizophrenia Acute Disease Disease Progression individualized prediction acute and transient psychotic disorder Female clinical prediction modeling business Follow-Up Studies 030217 neurology & neurosurgery Regular Articles Cohort study |
| Zdroj: | Damiani, S, Rutigliano, G, Fazia, T, Merlino, S, Berzuini, C, Bernardinelli, L, Politi, P & Fusar-Poli, P 2021, ' Developing and Validating an Individualized Clinical Prediction Model to Forecast Psychotic Recurrence in Acute and Transient Psychotic Disorders : Electronic Health Record Cohort Study ', Schizophrenia bulletin, vol. 47, no. 6, pp. 1695-1705 . https://doi.org/10.1093/schbul/sbab070 Schizophr Bull |
| ISSN: | 1745-1701 0586-7614 |
| DOI: | 10.1093/schbul/sbab070 |
| Popis: | Acute and transient psychotic disorders (ATPDs) include short-lived psychotic episodes with a high probability of developing psychotic recurrences. Clinical care for ATPD is currently limited by the inability to predict outcomes. Real-world electronic health record (EHR)-based retrospective cohort study STROBE/RECORD compliant included all individuals accessing the South London and Maudsley NHS Trust between 2006 and 2017 and receiving a first diagnosis of ATPD (F23, ICD-10). After imputing missing data, stepwise and LASSO Cox regression methods employing a priori predictors (n = 23) were compared to develop and internally validate an individualized risk prediction model to forecast the risk of psychotic recurrences following TRIPOD guidelines. The primary outcome was prognostic accuracy (area under the curve [AUC]). 3018 ATPD individuals were included (average age = 33.75 years, 52.7% females). Over follow-up (average 1042 ± 1011 days, up to 8 years) there were 1160 psychotic recurrences (events). Stepwise (n = 12 predictors) and LASSO (n = 17 predictors) regression methods yielded comparable prognostic accuracy, with an events per variable ratio >100 for both models. Both models showed an internally validated adequate prognostic accuracy from 4 years follow-up (AUC 0.70 for both models) and good calibration. A refined model was adapted in view of the new ICD-11 criteria on 307 subjects with polymorphic ATPD, showing fair prognostic accuracy at 4 years (AUC: stepwise 0.68; LASSO 0.70). This study presents the first clinically based prediction model internally validated to adequately predict long-term psychotic recurrence in individuals with ATPD. The model can be automatable in EHRs, supporting further external validations and refinements to improve its prognostic accuracy. |
| Databáze: | OpenAIRE |
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