Inflammatory and Cardiometabolic Markers at Presentation with First Episode Psychosis and Long-term Clinical Outcomes: a longitudinal study using electronic health records

Osimo, Emanuele F., Perry, Benjamin I., Cardinal, Rudolf N., Lynall, Mary-Ellen, Lewis, Jonathan, Kudchadkar, Aarti, Murray, Graham, Perez, Jesus, Jones, Peter B. and Khandaker, Golam M. (2020) Inflammatory and Cardiometabolic Markers at Presentation with First Episode Psychosis and Long-term Clinical Outcomes: a longitudinal study using electronic health records. Brain, Behavior, and Immunity. ISSN 0889-1591

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Abstract

Approximately one third of patients presenting with a first episode of psychosis need long-term support, but there is a limited understanding of the sociodemographic or biological factors that predict this outcome. We used electronic health records from a naturalistic cohort of consecutive patients referred to an early intervention in psychosis service to address this question. We extracted data on demographic (age, sex, ethnicity and marital status), immune (differential cell count measures and C-reactive protein (CRP)) and metabolic (cholesterol, triglycerides, glucose, glycated haemoglobin, blood pressure, body mass index (BMI)) factors at baseline, and subsequent need for long-term secondary (specialist) psychiatric care. Of 749 patients with outcome data available, 447 (60%) had a good outcome and were discharged to primary care, while 302 (40%) required follow-up by secondary mental health services indicating a worse outcome. The need for ongoing secondary mental healthcare was associated with high triglyceride levels (adjusted odds ratio/OR = 7.32, 95% CI 2.26–28.06), a low basophil:lymphocyte ratio (adjusted OR = 0.14, 95% CI 0.02–0.58), and a high monocyte count (adjusted OR = 2.78, 95% CI 1.02–8.06) at baseline. The associations for baseline basophil (unadjusted OR = 0.27 per SD, 95% CI 0.10–0.62) and platelet counts (unadjusted OR = 2.88, 95% CI 1.29–6.63) attenuated following adjustment for BMI. Baseline CRP levels or BMI were not associated with long-term psychiatric outcomes. In conclusion, we provide evidence that triglyceride levels and several blood cell counts measured at presentation may be clinically useful markers of long-term prognosis for first episode psychosis in clinical settings. These findings will require replication.

Item Type: Article
Uncontrolled Keywords: basophils,clinical outcome,early intervention,first episode psychosis,inflammation,longitudinal,metabolism,psychosis,schizophrenia,triglycerides,immunology,endocrine and autonomic systems,behavioral neuroscience ,/dk/atira/pure/subjectarea/asjc/2400/2403
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Medicine and Health Sciences > School of Health Sciences
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Depositing User: LivePure Connector
Date Deposited: 22 Sep 2020 23:58
Last Modified: 20 Oct 2020 23:56
URI: https://ueaeprints.uea.ac.uk/id/eprint/76982
DOI: 10.1016/j.bbi.2020.09.011

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