Probability of Transition to Psychosis in Individuals at Clinical High Risk An Updated Meta-analysis
Probability of Transition to Psychosis in Individuals at Clinical High Risk An Updated Meta-analysis
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DOI：
10.1001/jamapsychiatry.2021.0830
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发表时间：
2021-07-14
期刊：
影响因子：
25.8
通讯作者：
Fusar-Poli, Paolo
中科院分区：
文献类型：
--
作者：
de Pablo, Gonzalo Salazar;Radua, Joaquim;Fusar-Poli, Paolo
评估当前从临床高危精神病转变为精神病的可能性对于预防保健和应用研究至关重要。目的定量检查CHR-P中个体转变为精神病的风险的一致性和程度。数据来源PubMed和Web of Science数据库，直到2020年11月1日。手工检索以前文章中的参考文献。研究选择纵向研究报告在CHR-P个体中的转移风险。符合系统评价和荟萃分析(PRISMA)和流行病学观察性研究(MOOSE)报告指南的首选报告项目的数据提取和综合荟萃分析；独立的数据提取，手动和通过Kaplan-Meier曲线的数字化。主要结果和测量初级效果大小是在0.5、1、1.5、2、2.5、3、4和超过4年的随访中，使用每个时间点在CHR-P转变为精神病的个体的数量估计的累积转化为精神病的风险。这些分析得到了荟萃分析的Kaplan-Meier曲线和向精神病转变的速度(风险率)的补充。进行随机效应荟萃分析、研究间异质性分析、研究质量评估和元回归分析。结果共纳入130项研究，9222名研究对象。平均年龄20.3岁(4.4岁)，男性5100例(55.3%)。累积转移风险0.5年为0.09(95%CI，0.07~0.10；k=37；n=6485)，1年为0.15(95%CI，0.13~0.16；k=53；n=7907)，1.5年为0.20(95%CI，0.17~0.22；k=30；n=5488)，1.5年为0.19(95%CI，0.17~0.22；k=44；2a时为0.25(95%CI，0.21~0.29；k=19；n=3114)；3年时为0.25(95%CI，0.22~0.29；k=29；n=4029；n=4029)；4年时为0.27(95%CI，0.23~0.30；k=16；n=2926)；4年以上时为0.28(95%CI，0.20~0.37；k=14；n=2301)。累积Kaplan-Meier转移风险0.5年为0.08(95%CI，0.08~0.09；n=4860)，1年为0.14(95%CI，0.13~0.15；n=3408)，1.5年为0.17(95%CI，0.16~0.19；n=2892)，2年为0.20(95%CI，0.19~0.21；n=2357)，0.25(95%CI，0.23~0.26；3a为0.27(95%CI，0.25~0.28；n=1029；n=1029)，3.5年为0.28(95%CI，0.26~0.29；n=808)，4年为0.29(95%CI，0.27~0.30；n=737)，10年为0.35(95%CI，0.32~0.38；n=114)。风险率仅在随访4年时趋于平稳。Meta回归分析显示，女性比例较低(Beta=-0.02；95%CI，-0.04~-0.01)和较高比例的短暂局限性间歇性精神病症状(Beta=0.02；95%CI，0.01~0.03)与过渡风险增加有关。所有研究的异质性很高(I-2范围，77.91%到95.73%)。结论和在这项荟萃分析中，在CHR-P的25%的个体在3年内发展为精神病。从长期来看，转型风险继续增加。扩大临床监测和预防护理对这类患者可能是有益的。
IMPORTANCE Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to psychosis holds paramount importance for preventive care and applied research.OBJECTIVE To quantitatively examine the consistency and magnitude of transition risk to psychosis in individuals at CHR-P.DATA SOURCES PubMed and Web of Science databases until November 1, 2020. Manual search of references from previous articles.STUDY SELECTION Longitudinal studies reporting transition risks in individuals at CHR-P.DATA EXTRACTION AND SYNTHESIS Meta-analysis compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines; independent data extraction, manually and through digitalization of Kaplan-Meier curves.MAIN OUTCOME AND MEASURES Primary effect size was cumulative risk of transition to psychosis at 0.5, 1, 1.5, 2, 2.5, 3, 4, and more than 4 years' follow-up, estimated using the numbers of individuals at CHR-P transitioning to psychosis at each time point. These analyses were complemented by meta-analytical Kaplan-Meier curves and speed of transition to psychosis (hazard rate). Random-effects meta-analysis, between-study heterogeneity analysis, study quality assessment, and meta-regressions were conducted.RESULTS A total of 130 studies and 9222 individuals at CHR-P were included. The mean (SD) age was 20.3 (4.4) years, and 5100 individuals (55.3%) were male. The cumulative transition risk was 0.09 (95% CI, 0.07-0.10; k = 37; n = 6485) at 0.5 years, 0.15 (95% CI, 0.13-0.16; k = 53; n = 7907) at 1 year, 0.20 (95% CI, 0.17-0.22; k = 30; n = 5488) at 1.5 years, 0.19 (95% CI, 0.17-0.22; k = 44; n = 7351) at 2 years, 0.25 (95% CI, 0.21-0.29; k = 19; n = 3114) at 2.5 years, 0.25 (95% CI, 0.22-0.29; k = 29; n = 4029) at 3 years, 0.27 (95% CI, 0.23-0.30; k = 16; n = 2926) at 4 years, and 0.28 (95% CI, 0.20-0.37; k = 14; n = 2301) at more than 4 years. The cumulative Kaplan-Meier transition risk was 0.08 (95% CI, 0.08-0.09; n = 4860) at 0.5 years, 0.14 (95% CI, 0.13-0.15; n = 3408) at 1 year, 0.17 (95% CI, 0.16-0.19; n = 2892) at 1.5 years, 0.20 (95% CI, 0.19-0.21; n = 2357) at 2 years, 0.25 (95% CI, 0.23-0.26; n = 1444) at 2.5 years, 0.27 (95% CI, 0.25-0.28; n = 1029) at 3 years, 0.28 (95% CI, 0.26-0.29; n = 808) at 3.5 years, 0.29 (95% CI, 0.27-0.30; n = 737) at 4 years, and 0.35 (95% CI, 0.32-0.38; n = 114) at 10 years. The hazard rate only plateaued at 4 years' follow-up. Meta-regressions showed that a lower proportion of female individuals (beta = -0.02; 95% CI, -0.04 to -0.01) and a higher proportion of brief limited intermittent psychotic symptoms (beta = 0.02; 95% CI, 0.01-0.03) were associated with an increase in transition risk. Heterogeneity across the studies was high (I-2 range, 77.91% to 95.73%).CONCLUSIONS AND RELEVANCE In this meta-analysis, 25% of individuals at CHR-P developed psychosis within 3 years. Transition risk continued increasing in the long term. Extended clinical monitoring and preventive care may be beneficial in this patient population.