ArticleRisk management and healthcare policy2026
A Competing-Risk Nomogram for in-Hospital Non-Suicidal Self-Injury Recurrence Using Inflammatory and Clinical Predictors.
Article in Risk management and healthcare policy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Non-suicidal self-injury (NSSI) recurrence is an important safety concern in psychiatric inpatient care. This study aimed to identify predictors of subsequent in-hospital NSSI recurrence and develop an internally validated prediction model accounting for discharge as a competing event. Methods: This single-center retrospective cohort included 842 psychiatric inpatients aged 12-40 years. Admission clinical characteristics and inflammatory biomarkers were collected within the first 24 hours, while NSSI occurring during this period was recorded separately as an early in-hospital behavioral predictor. Subsequent NSSI recurrence was analyzed using Fine-Gray proportional subdistribution hazards models, with discharge without recurrence treated as a competing event. Non-linear associations were examined using restricted cubic splines. Internal validation was performed using 1000 bootstrap resamples with optimism correction. Results: The 14-day cumulative incidence of NSSI recurrence was 13.8%. Baseline NLR showed a significant non-linear association with recurrence risk. For exploratory model simplification, a maximally selected Gray statistic identified 2.45 as a data-derived NLR cutpoint. The multivariable Fine-Gray model identified six predictors: NSSI during the first 24 hours (sHR, 2.15), primary borderline personality disorder diagnosis (sHR, 1.88), childhood trauma or abuse (sHR, 1.65), prior suicide attempts (sHR, 1.42), NLR >2.45 (sHR, 1.58), and HAMD score (sHR per point, 1.05). The apparent C-index was 0.765, with an optimism-corrected value of 0.751. Calibration was acceptable at 7 and 14 days, and decision curve analysis suggested potential net benefit across selected threshold ranges. In sensitivity analysis excluding early NSSI, the C-index was 0.741 and the remaining predictor associations were generally maintained. Conclusion: Clinical history, depressive symptom burden, early in-hospital self-injury, and baseline NLR were associated with subsequent NSSI recurrence. The non-linear NLR association warrants further investigation, whereas early NSSI primarily reflects an already active crisis. The nomogram remains a research-stage risk-support model and requires prospective external validation before clinical implementation.
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