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Severe mental illness and mortality in sepsis and septic shock: a systematic review and meta-analysis

Molecular Psychiatry (2024)Cite this article

Subjects

Abstract

Background

There have been conflicting reports regarding the case-fatality outcomes associated with sepsis and septic shock in patients with severe mental illness (SMI).

Methods

We searched Medline®, Web of Science® and the Cochrane Library® databases (from inception to 4-July-2023) for papers reporting outcomes associated with sepsis and septic shock in adult with (cases) vs. without SMI (controls). The main study outcome was the unadjusted case-fatality rate at hospital discharge, or 30 days if unavailable. Secondary outcomes included the rates of adjusted case-fatality at hospital discharge.

Results

A total of six studies were included in the systematic review, of which four provided data for meta-analysis involving 2,124,072 patients. Compared to controls, patients with SMI were younger and more frequently women. Unadjusted analyses showed that SMI patients had a lower case-fatality rate associated with sepsis and septic shock than their non-SMI counterparts (OR 0.61, 95% CI [0.58–0.65], PI 95% CI [0.49–0.77], I2 = 91%). Meta-regression and subgroup analyses showed that the denominator of the study population (i.e. septic shock or sepsis) was associated with the outcome with an R2 of 59.7%.

Conclusion

In conclusion, our study reveals a survival advantage of SMI patients over their non-SMI counterparts. Further research is needed to fully elucidate the mechanisms involved and to develop targeted interventions that can improve the prognosis of both SMI and non-SMI patients facing sepsis.

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Data availability

Data is available in the literature corpus and can be find using the search strategy defined in the manuscript.

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Funding

Funding

The GERAR (Groupe Education Recherche en Anesthesie Reanimation) funded the use of the Covidence software.

Author information

Authors and Affiliations

  1. AP-HM, Aix-Marseille Univ, CEReSS, Health Service Research and Quality of Life Centre, School of Medicine - La Timone Medical, Marseille, France

    Ines Lakbar, Marc Leone, Laurent Boyer & Guillaume Fond

  2. Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France

    Ines Lakbar

  3. APHM, service de psychiatrie universitaire, Marseille, France

    Eloise Maakaron & Guillaume Fond

  4. Aix-Marseille University, AP–HM, North Hospital, Department of Anesthesia and Intensive Care Medicine, Marseille, France

    Marc Leone

  5. Anesthesiology and Intensive Care; Anesthesia and Critical Care Department C, Gui de Chauliac Teaching Hospital, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France

    Louis Delamarre

  6. Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea

    Dong Keon Yon

  7. Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

    Dong Keon Yon

  8. Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam

    Bach Tran

  9. FondaMental Fondation, Créteil, France

    Laurent Boyer & Guillaume Fond

Authors
  1. Ines Lakbar
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  7. Laurent Boyer
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  8. Guillaume Fond
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Contributions

Conceptualization, ML, GF, LB, IL ; methodology, ML, GF, LB, IL.; software, IL, LD; validation, ML, GF, LB, IL; formal analysis, IL, LD; investigation, IL, EM; data curation, IL, EM.; writing—original draft preparation, IL.; writing—review and editing, ML, GF, LB; visualization, IL, LD.; supervision, ML, GF, LB ; project administration, ML, GF, LB, IL. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Ines Lakbar.

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Lakbar, I., Maakaron, E., Leone, M. et al. Severe mental illness and mortality in sepsis and septic shock: a systematic review and meta-analysis. Mol Psychiatry (2024). https://doi.org/10.1038/s41380-024-02603-8

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