Algorithm predicts the risk of developing metabolic syndrome in young people with psychosis

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Perry reports that he received a grant from the National Institute for Health Research while conducting this study. Please refer to the study for all relevant financial information from the other authors.

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Researchers have developed an age-tailored algorithm that can predict the risk of developing metabolic syndrome in young people with psychosis, according to study results published in The Lancet Psychiatry.

“A recent systematic review examined the suitability of existing algorithms for predicting cardiometabolic risk for young people with psychosis.” Benjamin I. Perry, MRCPsych, of the Department of Psychiatry at the University of Cambridge in the UK, and colleagues wrote. “However, all algorithms were developed in samples of adults with a mean age over the included studies of 50.5 years, and no studies included participants under 35 years of age. Most of the included studies did not include relevant predictors such as antipsychotic drugs, so the review authors concluded that none are likely to be suitable for young people with psychosis. “

Infographic data derived from: Perry BI et al. Lancet psychiatry. 2021; doi: 10.1016 / S2215-0366 (21) 00114-0.

In addition, an exploratory analysis that accompanied the previous systematic review showed that existing algorithms significantly underestimate the cardiometabolic risk in young people at or at risk of developing psychosis.

In the current study, Perry and colleagues developed the Psychosis Metabolic Risk Calculator (PsyMetRiC) to predict up to 6 years of risk of developing metabolic syndrome in young people aged 16 to 35 with psychosis using data provided usually recorded at baseline. They used the forced entry method to develop a full model that included age, gender, ethnicity, BMI, smoking status, prescribing a metabolically active antipsychotic HDL level and triglyceride level, and a sub-model that excluded biochemical outcomes. In addition, they used data from two UK psychosis early intervention services between January 1, 2013 and November 4, 2020 to develop PsyMetRiC and validated it externally at another UK early intervention service between January 1, 2013 and November 4, 2020. They performed a sensitivity analysis of participants in the UK birth cohort aged 18 and over who were at risk of developing psychosis.

Researchers included 651 patients in the developmental sample, 510 in the validation sample, and 505 in the sensitivity analysis sample. The results showed a high level of performance for PsyMetRiC in internal and external validation. The researchers found a “good” calibration of the complete model, but found evidence of a slight mis-calibration of the partial model. PsyMetRiC improved the net benefit by 7.95% with a sensitivity of 75% and a specificity of 74% with a cutoff score of 0.18. This improvement was equivalent to detecting an additional 47% of metabolic syndrome cases.

“PsyMetRiC has the potential to become a valuable resource for healthcare professionals working in [early intervention services] by supporting informed choices of antipsychotic drugs, prescribing cardioprotective drugs, and non-pharmacological interventions, including lifestyle adjustments, to prevent future development of cardiometabolic comorbidities and the resulting years of life lost, ”wrote Perry and colleagues.

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