Tool for Predicting Cardiometabolic Risk in Young Patients with Psychotic Disorder
A study describing the development and validation of an algorithm for predicting cardiometabolic risk in patients with psychotic disorder, PsyMetRiC (Psychosis Metabolic Risk Calculator), was recently published in Lancet Psychiatry. British scientists have created a tool to estimate the risk of developing metabolic syndrome over the next 6 years, serving as a predictor of cardiovascular morbidity and mortality in young people with psychosis aged 16–35 years.
Methodology of PsyMetRiC and its Validation
The risk of developing cardiometabolic disorders is increased in patients with psychosis, including young individuals. However, until now, there has been no suitable validated tool to predict this risk.
The PsyMetRiC algorithm was created based on commonly recorded information in these patients. The authors prepared two versions: the complete model included age, gender, ethnicity, BMI, smoking, levels of HDL cholesterol and triglycerides, and the use of antipsychotics affecting metabolism, while the simplified model omitted laboratory parameters. Data from 2013–2020 from two geographically distinct early intervention in psychosis programs in the UK were utilized. External validation was then performed using data from another similarly focused program. Sensitivity analysis included a cohort of individuals over 18 years old at risk of developing psychosis.
Results
Data from 651 patients were used to create the algorithm, 510 for validation, and 505 for sensitivity analysis. Both the complete and simplified models showed good results in internal and external validation and sensitivity analysis. Calibration showed better reliability of the complete model. At a risk threshold of 0.18, the complete model was able to capture 47% more cases of metabolic syndrome.
Discussion and Conclusion
PsyMetRiC cannot yet be recommended for clinical use as it requires prospective validation in a larger sample of patients, assessment of economic benefits, and regulatory approval. However, in the future, it could become a useful tool for improving care for young patients with psychosis. It could provide healthcare professionals with additional information for selecting antipsychotics, prescribing cardioprotective medications, and recommending non-pharmacological interventions, such as lifestyle modifications, aiming to prevent cardiometabolic comorbidities and shorten lifespan.
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Source: Perry B. I., Osimo E. F., Upthegrove R. et al. Development and external validation of the Psychosis Metabolic Risk Calculator (PsyMetRiC): a cardiometabolic risk prediction algorithm for young people with psychosis. Lancet Psychiatry 2021 Jul; 8 (7): 589−598, doi: 10.1016/S2215-0366(21)00114-0.
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