Association of severe mental illness and septic shock case fatality rate in patients admitted to the intensive care unit: A national population-based cohort study

• Published in: PLoS medicine 2023-03, Vol.20 (3), p.e1004202
• Main Authors: Lakbar, Ines, Leone, Marc, Pauly, Vanessa, Orleans, Veronica, Srougbo, Kossi Josue, Diao, Sambou, Llorca, Pierre-Michel, Solmi, Marco, Correll, Christoph U, Fernandes, Sara, Vincent, Jean-Louis, Boyer, Laurent, Fond, Guillaume
• Format: Article
• Language: English
• Subjects: Addiction; Addictions; Adult; Biology and Life Sciences; Bipolar disorder; Body weight; Care and treatment; Codes; Cognitive science; Cohort analysis; Cohort Studies; Comorbidity; Comparative analysis; Complications and side effects; Depression, Mental; Depressive Disorder, Major - epidemiology; Diagnosis; Drug addiction; Fatalities; Health aspects; Hospital patients; Hospitalization; Hospitals; Human health and pathology; Humans; Infections; Intensive care; Intensive Care Units; Length of stay; Life Sciences; Medical research; Medicine and Health Sciences; Medicine, Experimental; Mental depression; Mental disorders; Mental Disorders - epidemiology; Mental illness; Metabolism; Mortality; Obesity; Overweight; Pathogens; Patients; Physiological aspects; Population studies; Population-based studies; Prevention; Psychiatrics and mental health; Psychology; Regression analysis; Retrospective Studies; Risk factors; Schizophrenia; Sepsis; Septic shock; Shock, Septic; Social Sciences; Variables
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1004202

Patients with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, or major depressive disorder) have been reported to have excess mortality rates from infection compared to patients without SMI, but whether SMI is associated with higher or lower case fatality rates (CFRs) among infected patients remains unclear. The primary objective was to compare the 90-day CFR in septic shock patients with and without SMI admitted to the intensive care unit (ICU), after adjusting for social disadvantage and physical health comorbidity. We conducted a nationwide, population-based cohort study of all adult patients with septic shock admitted to the ICU in France between January 1, 2014, and December 31, 2018, using the French national hospital database. We matched (within hospitals) in a ratio of 1:up to 4 patients with and without SMI (matched-controls) for age (5 years range), sex, degree of social deprivation, and year of hospitalization. Cox regression models were conducted with adjustment for smoking, alcohol and other substance addiction, overweight or obesity, Charlson comorbidity index, presence of trauma, surgical intervention, Simplified Acute Physiology Score II score, organ failures, source of hospital admission (home, transfer from other hospital ward), and the length of time between hospital admission and ICU admission. The primary outcome was 90-day CFR. Secondary outcomes were 30- and 365-day CFRs, and clinical profiles of patients. A total of 187,587 adult patients with septic shock admitted to the ICU were identified, including 3,812 with schizophrenia, 2,258 with bipolar disorder, and 5,246 with major depressive disorder. Compared to matched controls, the 90-day CFR was significantly lower in patients with schizophrenia (1,052/3,269 = 32.2% versus 5,000/10,894 = 45.5%; adjusted hazard ratio (aHR) = 0.70, 95% confidence interval (CI) 0.65,0.75, p < 0.001), bipolar disorder (632/1,923 = 32.9% versus 2,854/6,303 = 45.3%; aHR = 0.70, 95% CI = 0.63,0.76, p < 0.001), and major depressive disorder (1,834/4,432 = 41.4% versus 6,798/14,452 = 47.1%; aHR = 0.85, 95% CI = 0.81,0.90, p < 0.001). Study limitations include inability to capture deaths occurring outside hospital, lack of data on processes of care, and problems associated with missing data and miscoding in medico-administrative databases. Our findings suggest that, after adjusting for social disadvantage and physical health comorbidity, there are improved septic shock outcome in patients