Development and Internal Validation of a Risk Prediction Model for Clozapine-Induced Gastrointestinal Hypomotility: A Single-Center Retrospective Cohort Study.
- 1Psychological Health Center, Beijing United Family Rehabilitation Hospital, Beijing, 100016, People's Republic of China.
- 2Ultrasound Department, Beijing United Family Hospital, Beijing, 100015, People's Republic of China.
- 3Medical Affairs Office, Beijing United Family Rehabilitation Hospital, Beijing, 100016, People's Republic of China.
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
CIGH occurred in 356 of 1,426 patients (24.96%). Six predictors were retained: age ≥60 years (OR 1.469, 95% CI 1.031-2.094), BMI <24 kg/m² (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.
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BibTeX
@article{tian2026development,
title = {{Development and Internal Validation of a Risk Prediction Model for Clozapine-Induced Gastrointestinal Hypomotility: A Single-Center Retrospective Cohort Study.}},
author = {Feng-Jun Tian and Yong Zhang and Jiang-Ke Tian and Hong-Li Cui and Ping Song},
journal = {Risk management and healthcare policy},
year = {2026},
month = oct,
doi = {10.2147/rmhp.s656510},
url = {https://europepmc.org/article/MED/42974511},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Development and Internal Validation of a Risk Prediction Model for Clozapine-Induced Gastrointestinal Hypomotility: A Single-Center Retrospective Cohort Study.
AU - Feng-Jun Tian
AU - Yong Zhang
AU - Jiang-Ke Tian
AU - Hong-Li Cui
AU - Ping Song
PY - 2026
DA - 2026/10/29
JO - Risk management and healthcare policy
DO - 10.2147/rmhp.s656510
UR - https://europepmc.org/article/MED/42974511
AB - 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 CIGH occurred in 356 of 1,426 patients (24.96%). Six predictors were retained: age ≥60 years (OR 1.469, 95% CI 1.031-2.094), BMI <24 kg/m² (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.
SN - 1179-1594
ER -