Development of a Prognostic Stratification Scale for Cardiovascular Death in Patients with Schizophrenia
Berkis Martínez Hernández, Lidiver Martínez Calderón, Betsy Lidivet Bonachea Sánchez, Ederlys Martín García, Nailanys Puertos Matos, Juan Carlos Mirabal Requena.
Introduction: Patients with schizophrenia have a 15-20 year reduced life expectancy compared to the general population, with cardiovascular diseases being the leading cause of death. Conventional cardiovascular risk scales (Framingham, SCORE, REGICOR) have significant limitations as they do not include specific variables for mental illness and are not validated for the Cuban socioeconomic and healthcare context.
Objective: To develop and validate a prognostic model and cardiovascular death risk stratification scale specific for patients with schizophrenia in Sancti Spíritus province, Cuba.
Methods: An observational analytical study for prognostic model development with prospective cohort design was designed. 350 patients with schizophrenia diagnosis (ICD-10) from “Camilo Cienfuegos” Provincial General Hospital in Sancti Spíritus will be recruited, with 24-month prospective follow-up. Study variables will include demographic dimensions (age, sex, disease evolution time), clinical (BMI, blood pressure, smoking, sedentary behavior), psychiatric (schizophrenia subtype, antipsychotic treatment), hemochemical parameters (lipid profile, blood glucose, creatinine) and socio-environmental factors (social support, family functioning, educational level). Statistical analysis will follow a sequential strategy: descriptive analysis, univariate analysis (Chi-square, t-Student tests), survival analysis using Cox regression to identify independent prognostic factors, prognostic model development based on Beta coefficients, scoring scale elaboration, and internal validation through bootstrapping with 1,000 resamples.
Expected results: Based on reviewed literature, independent prognostic factors anticipated include: age > 50 years (expected RR: 2.1; 95%CI: 1.8 2.5), schizophrenia evolution time > 10 years (RR: 1.8; 95%CI: 1.5-2.2), use of high metabolic risk atypical antipsychotics (RR: 1.5; 95%CI: 1.2-1.9), HDL cholesterol < 40 mg/dL (RR: 2.2; 95%CI: 1.8-2.7), and low family social support (RR: 1.9; 95%CI: 1.6-2.3). The final model will include 6-8 significant predictor variables (p < 0.05) and demonstrate adequate discriminatory capacity (Harrell’s C-index > 0.75) and calibration.
Conclusions: These findings confirm the existing idea that alcohol makes a significant contribution to the burden of suicide mortality in the European region. These results also suggest that alcohol is a key predictor of the East-West gap in suicide rates.
