Risk of readmission in patients with schizophrenia and schizoaffective disorder newly prescribed clozapine
Risk of readmission in patients with schizophrenia and schizoaffective disorder newly prescribed clozapine
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DOI：
10.1177/0269881118817387
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发表时间：
2019-04-01
影响因子：
4.1
通讯作者：
Hayes, Richard D.
中科院分区：
文献类型：
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作者：
Kesserwani, Jad;Kadra, Giouliana;Hayes, Richard D.
背景：目前的研究缺乏对混杂变量的控制，这限制了对氯氮平疗效的深入了解。我们的目的是调查精神分裂症和情感性精神障碍患者出院时处方的氯氮平与再次进入二级精神卫生服务的风险之间的关系，广泛控制混杂变量。方法：在一项回顾性观察性队列研究中分析了3651例患者的临床记录。考克斯比例风险回归模型被用来评估再入院的风险。还进行了一系列敏感性分析。使用倾向评分方法解决适应症混淆问题。结果如下：与使用其他抗精神病药物的患者相比，使用氯氮平的患者（n=202）的再入院风险降低（校正风险比=0.79; 95%置信区间：0.64-0.99; p=0.043）。与奥氮平相比，氯氮平对再入院风险也有保护作用（校正的风险比为0.76; 95%置信区间：0.60-0.96; p=0.021）。在调整一系列可能的混杂因素后，以及使用倾向评分来解决适应症的混杂因素后，效应量保持一致。除两项敏感性分析外，其他所有分析均观察到统计学显著性结果。结论：我们的研究结果表明，氯氮平与降低再入院进入二级精神卫生服务的风险有关。
Background: Insight into the effect of clozapine is limited by a lack of controlling for confounding variables in current research. Our objective was to investigate the association between clozapine prescribed at discharge, following an inpatient episode, and risk of readmission into secondary mental health services in patients with schizophrenia and schizoaffective disorder, controlling extensively for confounding variables. Methods: Clinical records from 3651 patients were analysed in a retrospective observational cohort study. Cox proportional-hazards regression models were used to assess the risk of hospital readmission. A series of sensitivity analyses were also conducted. Propensity score methods were used to address confounding-by-indication. Results: Patients on clozapine (n=202) had a reduced risk of readmission compared with patients on other antipsychotics (adjusted hazard ratio=0.79; 95% confidence interval: 0.64-0.99; p=0.043). Clozapine also had a protective effect on risk of readmission when compared with olanzapine (adjusted hazard ratio 0.76; 95% confidence interval: 0.60-0.96; p=0.021). The effect size remained consistent after adjusting for an array of possible confounders, as well as using propensity scores to address confounding-by-indication. A statistically significant result was also noted in all but two sensitivity analyses. Conclusion: Our findings suggest that clozapine is associated with a reduced risk of readmission into secondary mental health services.