Importance Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to psychosis holds paramount importance for preventive care and applied research. Objective To quantitatively examine the consistency and magnitude of transition risk to psychosis in individuals at CHR-P. Data Sources PubMed and Web of Science databases until November 1, 2020. Manual search of references from previous articles. Study Selection Longitudinal studies reporting transition risks in individuals at CHR-P. Data Extraction and Synthesis Meta-analysis compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines; independent data extraction, manually and through digitalization of Kaplan-Meier curves. Main Outcome and Measures Primary effect size was cumulative risk of transition to psychosis at 0.5, 1, 1.5, 2, 2.5, 3, 4, and more than 4 years' follow-up, estimated using the numbers of individuals at CHR-P transitioning to psychosis at each time point. These analyses were complemented by meta-analytical Kaplan-Meier curves and speed of transition to psychosis (hazard rate). Random-effects meta-analysis, between-study heterogeneity analysis, study quality assessment, and meta-regressions were conducted. Results A total of 130 studies and 9222 individuals at CHR-P were included. The mean (SD) age was 20.3 (4.4) years, and 5100 individuals (55.3%) were male. The cumulative transition risk was 0.09 (95% CI, 0.07-0.10; k = 37; n = 6485) at 0.5 years, 0.15 (95% CI, 0.13-0.16; k = 53; n = 7907) at 1 year, 0.20 (95% CI, 0.17-0.22; k = 30; n = 5488) at 1.5 years, 0.19 (95% CI, 0.17-0.22; k = 44; n = 7351) at 2 years, 0.25 (95% CI, 0.21-0.29; k = 19; n = 3114) at 2.5 years, 0.25 (95% CI, 0.22-0.29; k = 29; n = 4029) at 3 years, 0.27 (95% CI, 0.23-0.30; k = 16; n = 2926) at 4 years, and 0.28 (95% CI, 0.20-0.37; k = 14; n = 2301) at more than 4 years. The cumulative Kaplan-Meier transition risk was 0.08 (95% CI, 0.08-0.09; n = 4860) at 0.5 years, 0.14 (95% CI, 0.13-0.15; n = 3408) at 1 year, 0.17 (95% CI, 0.16-0.19; n = 2892) at 1.5 years, 0.20 (95% CI, 0.19-0.21; n = 2357) at 2 years, 0.25 (95% CI, 0.23-0.26; n = 1444) at 2.5 years, 0.27 (95% CI, 0.25-0.28; n = 1029) at 3 years, 0.28 (95% CI, 0.26-0.29; n = 808) at 3.5 years, 0.29 (95% CI, 0.27-0.30; n = 737) at 4 years, and 0.35 (95% CI, 0.32-0.38; n = 114) at 10 years. The hazard rate only plateaued at 4 years' follow-up. Meta-regressions showed that a lower proportion of female individuals (β = -0.02; 95% CI, -0.04 to -0.01) and a higher proportion of brief limited intermittent psychotic symptoms (β = 0.02; 95% CI, 0.01-0.03) were associated with an increase in transition risk. Heterogeneity across the studies was high (I2 range, 77.91% to 95.73%). Conclusions and Relevance In this meta-analysis, 25% of individuals at CHR-P developed psychosis within 3 years. Transition risk continued increasing in the long term. Extended clinical monitoring and preventive care may be beneficial in this patient population.

中文翻译：

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临床高危个体转变为精神病的概率：一项更新的荟萃分析。

重要性 估计当前从临床高危精神病 (CHR-P) 转变为精神病的可能性对于预防保健和应用研究至关重要。目的 定量检查 CHR-P 个体向精神病转变风险的一致性和程度。数据源 PubMed 和 Web of Science 数据库，截至 2020 年 11 月 1 日。手动搜索以前文章的参考文献。研究选择 报告 CHR-P 个人过渡风险的纵向研究。符合系统评价和荟萃分析 (PRISMA) 和流行病学观察性研究荟萃分析 (MOOSE) 报告指南的首选报告项目的数据提取和综合荟萃分析；独立的数据提取，手动和通过 Kaplan-Meier 曲线的数字化。主要结果和测量 主要效应量是在 0.5、1、1.5、2、2.5、3、4 和 4 年以上的随访中转变为精神病的累积风险，使用 CHR-P 转变的个体数量估计精神病在每个时间点。这些分析得到了元分析 Kaplan-Meier 曲线和向精神病转变的速度（危险率）的补充。进行了随机效应荟萃分析、研究间异质性分析、研究质量评估和荟萃回归。结果共纳入 CHR-P 的 130 项研究和 9222 名个体。平均 (SD) 年龄为 20.3 (4.4) 岁，5100 人 (55.3%) 为男性。0.5 年时的累积过渡风险为 0.09（95% CI，0.07-0.10；k = 37；n = 6485），1 年时为 0.15（95% CI，0.13-0.16；k = 53；n = 7907），0.20 （95% CI，0.17-0.22；k = 30；n = 5488）在 1.5 年，0.19（95% CI，0.17-0.22；k = 44；n = 7351）在 2 年，0.25（95% CI，0.21-0.29；k = 19；n = 3114）在 2.5 0.25 (95% CI, 0.22-0.29; k = 29; n = 4029) 3 年，0.27 (95% CI, 0.23-0.30; k = 16; n = 2926) 4 年，0.28 (95 % CI，0.20-0.37；k = 14；n = 2301）超过 4 年。累积 Kaplan-Meier 过渡风险在 0.5 年时为 0.08（95% CI，0.08-0.09；n = 4860），在 1 年时为 0.14（95% CI，0.13-0.15；n = 3408），0.17（95% CI， 0.16-0.19；n = 2892）在 1.5 年，0.20（95% CI，0.19-0.21；n = 2357）在 2 年，0.25（95% CI，0.23-0.26；n = 1444）在 2.5 年，0.27（ 95% CI，0.25-0.28；n = 1029）在 3 年，0.28（95% CI，0.26-0.29；n = 808）在 3.5 年，0.29（95% CI，0.27-0.30；n = 737）在 4年，10 年时为 0.35（95% CI，0.32-0.38；n = 114）。危险率仅在 4 年的随访中趋于稳定。Meta 回归显示，女性个体的比例较低（β = -0.02；95% CI，-0.04 至 -0.01），而短暂受限的间歇性精神病症状比例较高（β = 0.02；95% CI，0.01-0.03）与过渡风险的增加有关。研究的异质性很高（I2 范围，77.91% 至 95.73%）。结论和相关性 在这项荟萃分析中，25% 的 CHR-P 个体在 3 年内发展为精神病。从长远来看，转型风险继续增加。扩展的临床监测和预防性护理可能对这一患者群体有益。研究的异质性很高（I2 范围，77.91% 至 95.73%）。结论和相关性 在这项荟萃分析中，25% 的 CHR-P 个体在 3 年内发展为精神病。从长远来看，转型风险继续增加。扩展的临床监测和预防性护理可能对这一患者群体有益。研究的异质性很高（I2 范围，77.91% 至 95.73%）。结论和相关性 在这项荟萃分析中，25% 的 CHR-P 个体在 3 年内发展为精神病。从长远来看，转型风险继续增加。扩展的临床监测和预防性护理可能对这一患者群体有益。