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



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


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.


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%.


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

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Authors and Affiliations



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.

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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).

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