Work

Development and Internal Validation of a Risk Prediction Model for Clozapine-Induced Gastrointestinal Hypomotility: A Single-Center Retrospective Cohort Study

Year: 2026

Type: article

Abstract: Objective: To develop and internally validate a prediction model for a first episode of clozapine-induced gastrointestinal hypomotility (CIGH) in clozapine-treated psychiatric inpatients. Methods: In this single-center retrospective cohort study, 1,426 adults with schizophrenia, schizoaffective disorder or bipolar disorder who had received clozapine for at least 4 weeks and were admitted to the Department of Psychiatry of Beijing United Family Rehabilitation Hospital between January 2019 and December 2025 were included. The index date was defined as the date of the current psychiatric admission, and all predictors were measured at or before that date. The outcome was a first CIGH event within 90 days, defined as paralytic ileus or intestinal obstruction, severe constipation requiring pharmacological intervention, or fecal impaction. Predictors were selected using LASSO regression, and the model was constructed with multivariable logistic regression. Performance was assessed using the area under the receiver operating characteristic curve (AUC), the calibration curve and decision curve analysis, and internal validation used 1,000 bootstrap resamples. Static and interactive (Shiny) nomograms were developed. Results: (OR 1.699, 95% CI 1.099-2.628), daily clozapine dose ≥300 mg (OR 2.276, 95% CI 1.531-3.384), clozapine treatment duration ≥5 years (OR 2.309, 95% CI 1.431-3.725), concomitant use of trihexyphenidyl (OR 3.322, 95% CI 2.291-4.818) and predominantly bedridden status (OR 2.608, 95% CI 1.817-3.744). Discrimination was moderate (AUC 0.731, 95% CI 0.694-0.768; bootstrap-corrected AUC 0.718), calibration was acceptable, and decision curve analysis indicated net benefit across threshold probabilities of 15%-70%. Conclusion: This internally validated model provides a non-invasive aid for stratifying 90-day CIGH risk in clozapine-treated psychiatric inpatients and for structuring gastrointestinal monitoring. External validation and prospective evaluation of clinical utility are required before routine implementation.

Source: Risk Management and Healthcare Policy

DOI: 10.2147/rmhp.s656510

Authors: Feng-Jun Tian, Yong Zhang, Jiang-Ke Tian, Hong-Li Cui, Ping Song

Institution: Beijing United Family Hospital

Language: English

Topic: Schizophrenia research and treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836