Frontiers in medicine · 2026
Clinical characteristics and risk factors for septic shock in neonates with early-onset sepsis: a matched case-control study.
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Liu Juan, Hu Jinhui, Li Lei, Zhou Jiajia, Wang Yajuan, Pan Zhaojun
Аннотация
BACKGROUND: Early-onset neonatal sepsis (EOS) progresses rapidly, and the development of septic shock is accompanied by a marked increase in case-fatality. This study aimed to systematically characterize the clinical features of, and identify factors associated with septic shock in neonates with EOS.
METHODS: Neonates with EOS complicated by septic shock who were admitted to Huai'an Maternal and Child Health Care Center constituted the case group. Controls were non-shock EOS neonates hospitalized during the same period and meeting the same inclusion criteria, selected at a 1:2 case-to-control ratio matched on gestational age and birth weight. Clinical and laboratory variables were collected and compared between groups. Candidate variables were screened by LASSO regression and subsequently entered into multivariable logistic regression. The predictive performance of the resulting variables was evaluated by receiver operating characteristic (ROC) curve analysis with bootstrap internal validation.
RESULTS: A total of 43 neonates with EOS complicated by septic shock and 86 matched non-shock controls were included. The two groups were comparable with respect to sex, gestational age, birth weight, mode of delivery, and major perinatal factors (all P > 0.05). LASSO regression retained four variables with non-zero coefficients. In subsequent multivariable analysis, higher prealbumin (OR = 0.945, 95% CI: 0.898-0.994, P = 0.028) and higher systemic immune-inflammation index (SII; OR = 0.958, 95% CI: 0.930-0.992, P = 0.025) were independently associated with lower odds of septic shock, whereas a higher procalcitonin-to-prealbumin (PCT/prealbumin) ratio was independently associated with higher odds of septic shock (OR = 3.061, 95% CI: 1.244-7.531, P = 0.015). ROC analysis showed that prealbumin, SII, and the PCT/prealbumin ratio each had acceptable predictive performance, and their combination yielded an AUC of 0.851 (95% CI: 0.764-0.939), with a sensitivity of 83.53% and a specificity of 85.41%; the bootstrap-corrected AUC 0.811 and LOOCV AUC 0.804.
CONCLUSIONS: Higher prealbumin and SII levels were inversely associated with septic shock in neonates with EOS, whereas a higher PCT/prealbumin ratio was positively associated with septic shock. These findings may provide additional insight into the inflammatory and metabolic characteristics associated with greater disease severity in this population.
METHODS: Neonates with EOS complicated by septic shock who were admitted to Huai'an Maternal and Child Health Care Center constituted the case group. Controls were non-shock EOS neonates hospitalized during the same period and meeting the same inclusion criteria, selected at a 1:2 case-to-control ratio matched on gestational age and birth weight. Clinical and laboratory variables were collected and compared between groups. Candidate variables were screened by LASSO regression and subsequently entered into multivariable logistic regression. The predictive performance of the resulting variables was evaluated by receiver operating characteristic (ROC) curve analysis with bootstrap internal validation.
RESULTS: A total of 43 neonates with EOS complicated by septic shock and 86 matched non-shock controls were included. The two groups were comparable with respect to sex, gestational age, birth weight, mode of delivery, and major perinatal factors (all P > 0.05). LASSO regression retained four variables with non-zero coefficients. In subsequent multivariable analysis, higher prealbumin (OR = 0.945, 95% CI: 0.898-0.994, P = 0.028) and higher systemic immune-inflammation index (SII; OR = 0.958, 95% CI: 0.930-0.992, P = 0.025) were independently associated with lower odds of septic shock, whereas a higher procalcitonin-to-prealbumin (PCT/prealbumin) ratio was independently associated with higher odds of septic shock (OR = 3.061, 95% CI: 1.244-7.531, P = 0.015). ROC analysis showed that prealbumin, SII, and the PCT/prealbumin ratio each had acceptable predictive performance, and their combination yielded an AUC of 0.851 (95% CI: 0.764-0.939), with a sensitivity of 83.53% and a specificity of 85.41%; the bootstrap-corrected AUC 0.811 and LOOCV AUC 0.804.
CONCLUSIONS: Higher prealbumin and SII levels were inversely associated with septic shock in neonates with EOS, whereas a higher PCT/prealbumin ratio was positively associated with septic shock. These findings may provide additional insight into the inflammatory and metabolic characteristics associated with greater disease severity in this population.