Clinical characteristics and risk factors for septic shock in neonates with early-onset sepsis: a matched case-control study.

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 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.