{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:37:07Z","timestamp":1793407027145,"version":"4.5.0"},"reference-count":51,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Neuroleptic malignant syndrome (NMS) is a potentially fatal, idiosyncratic reaction to antipsychotics. Due to low incidence of NMS, research on risk factors of mortality associated with NMS is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two authors independently searched Medline\/Embase\/Cochrane\/CINAHL\/PsychINFO databases for case reports with author\u2010defined NMS published in English until 05\/30\/2020. Demographic, clinical, treatment, and outcome data were independently extracted following PRISMA guidelines. NMS severity was rated using the Francis\u2010Yacoub scale. Mortality risk factors were identified using a multivariable regression analysis including all characteristics that were significantly different between NMS cases resulting vs. not resulting in death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      683 cases with NMS were analyzed (median age = 36\u00a0years, males = 62.1%). In a multivariable model, independent predictors of NMS mortality were lack of antipsychotic discontinuation (odds ratio (OR) = 4.39 95% confidence interval (CI) = 2.14\u20138.99;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0001), respiratory problems (OR = 3.54 95%CI = 1.71\u20137.32;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0004), severity of hyperthermia (Unit\u2010OR = 1.30, 95%CI = 1.16\u20131.46;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0001), and older age (Unit\u2010OR = 1.05, 95%CI = 1.02\u20131.07;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0014). Even in univariate, patient\u2010level analyses, antipsychotic formulation was not related to death (oral antipsychotic (OAP):\n                      <jats:italic>n<\/jats:italic>\n                      = 39\/554 (7.0%) vs. long\u2010acting injectable (LAI):\n                      <jats:italic>n<\/jats:italic>\n                      = 13\/129 (10.1%);\n                      <jats:italic>p<\/jats:italic>\n                      = 0.2413). Similarly, death with NMS was not related to antipsychotic class (first\u2010generation antipsychotic:\n                      <jats:italic>n<\/jats:italic>\n                      = 38\/433 (8.8%) vs. second\u2010generation antipsychotic:\n                      <jats:italic>n<\/jats:italic>\n                      = 8\/180 (4.4%);\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0638). Non\u2010antipsychotic co\u2010treatments were not associated with NMS mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite reliance on case reports, these findings indicate that presence of respiratory alterations, severity of hyperthermia, and older age should alert clinicians to a higher NMS mortality risk, and that antipsychotics should be stopped to reduce mortality, yet when NMS arises on LAIs, mortality is not increased vs. OAPs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13359","type":"journal-article","created":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T14:24:03Z","timestamp":1628259843000},"page":"329-341","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["A systematic review and pooled, patient\u2010level analysis of predictors of mortality in neuroleptic malignant syndrome"],"prefix":"10.1111","volume":"144","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5078-6716","authenticated-orcid":false,"given":"Daniel","family":"Guinart","sequence":"first","affiliation":[{"name":"Division of Psychiatry Research The Zucker Hillside Hospital Northwell Health New York NY USA"},{"name":"Center for Psychiatric Neuroscience Feinstein Institutes for Medical Research Manhasset NY USA"},{"name":"Department of Psychiatry Donald and Barbara Zucker School of Medicine at Northwell\/Hofstra Hempstead NY USA"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mar d'Investigacions M\u00e8diques (IMIM), Departament de Psiquiatria Universitat Aut\u00f2noma de Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuminari","family":"Misawa","sequence":"additional","affiliation":[{"name":"Yamanashi Prefectural KITA Hospital Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Rubio","sequence":"additional","affiliation":[{"name":"Division of Psychiatry Research The Zucker Hillside Hospital Northwell Health New York NY USA"},{"name":"Center for Psychiatric Neuroscience Feinstein Institutes for Medical Research Manhasset NY USA"},{"name":"Department of Psychiatry Donald and Barbara Zucker School of Medicine at Northwell\/Hofstra Hempstead NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Pereira","sequence":"additional","affiliation":[{"name":"Division of Psychiatry Research The Zucker Hillside Hospital Northwell Health New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"de Filippis","sequence":"additional","affiliation":[{"name":"Division of Psychiatry Research The Zucker Hillside Hospital Northwell Health New York NY USA"},{"name":"Psychiatry Unit Department of Health Sciences University Magna Graecia of Catanzaro Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Gastaldon","sequence":"additional","affiliation":[{"name":"Division of Psychiatry Research The Zucker Hillside Hospital Northwell Health New York NY USA"},{"name":"Department of Neuroscience, Biomedicine and Movement Sciences Section of Psychiatry University of Verona Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Kane","sequence":"additional","affiliation":[{"name":"Division of Psychiatry Research The Zucker Hillside Hospital Northwell Health New York NY USA"},{"name":"Center for Psychiatric Neuroscience Feinstein Institutes for Medical Research Manhasset NY USA"},{"name":"Department of 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