BACKGROUND: Young people with psychosis are at high risk of developing cardiometabolic disorders; however, there is no suitable cardiometabolic risk prediction algorithm for this group. We aimed to develop and externally validate a cardiometabolic risk prediction algorithm for young people with psychosis. METHODS: We developed the Psychosis Metabolic Risk Calculator (PsyMetRiC) to predict up to 6-year risk of incident metabolic syndrome in young people (aged 16-35 years) with psychosis from commonly recorded information at baseline. We developed two PsyMetRiC versions using the forced entry method: a full model (including age, sex, ethnicity, body-mass index, smoking status, prescription of a metabolically active antipsychotic medication, HDL concentration, and triglyceride concentration) and a partial model excluding biochemical results. PsyMetRiC was developed using data from two UK psychosis early intervention services (Jan 1, 2013, to Nov 4, 2020) and externally validated in another UK early intervention service (Jan 1, 2012, to June 3, 2020). A sensitivity analysis was done in UK birth cohort participants (aged 18 years) who were at risk of developing psychosis. Algorithm performance was assessed primarily via discrimination (C statistic) and calibration (calibration plots). We did a decision curve analysis and produced an online data-visualisation app. FINDINGS: 651 patients were included in the development samples, 510 in the validation sample, and 505 in the sensitivity analysis sample. PsyMetRiC performed well at internal (full model: C 0·80, 95% CI 0·74-0·86; partial model: 0·79, 0·73-0·84) and external validation (full model: 0·75, 0·69-0·80; and partial model: 0·74, 0·67-0·79). Calibration of the full model was good, but there was evidence of slight miscalibration of the partial model. At a cutoff score of 0·18, in the full model PsyMetRiC improved net benefit by 7·95% (sensitivity 75%, 95% CI 66-82; specificity 74%, 71-78), equivalent to detecting an additional 47% of metabolic syndrome cases. INTERPRETATION: We have developed an age-appropriate algorithm to predict the risk of incident metabolic syndrome, a precursor of cardiometabolic morbidity and mortality, in young people with psychosis. PsyMetRiC has the potential to become a valuable resource for early intervention service clinicians and could enable personalised, informed health-care decisions regarding choice of antipsychotic medication and lifestyle interventions. FUNDING: National Institute for Health Research and Wellcome Trust.

Birmingham Women's and Children's NHS Trust Early Intervention Service Birmingham UK

Centre for Academic Mental Health Population Health Sciences Bristol Medical School University of Bristol Bristol UK; MRC Centre for Neuropsychiatric Genetics and Genomics Cardiff University Cardiff UK

Department of Psychiatry University of Cambridge Cambridge UK; Cambridgeshire and Peterborough NHS Foundation Trust Cambridge UK

Department of Psychiatry University of Cambridge Cambridge UK; Cambridgeshire and Peterborough NHS Foundation Trust Cambridge UK; Centre for Academic Mental Health Population Health Sciences Bristol Medical School University of Bristol Bristol UK; MRC Integrative Epidemiology Unit Population Health Sciences Bristol Medical School University of Bristol Bristol UK

Department of Psychiatry University of Cambridge Cambridge UK; Cambridgeshire and Peterborough NHS Foundation Trust Cambridge UK; MRC London Institute of Medical Sciences Institute of Clinical Sciences Imperial College London UK

Department of Psychiatry University of Cambridge Cambridge UK; Department of Kinanthropology Charles University Prague Czech Republic

Institute for Mental Health University of Birmingham Birmingham UK

MRC London Institute of Medical Sciences Institute of Clinical Sciences Imperial College London UK; Institute of Psychiatry Psychology and Neuroscience King's College London London UK

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