Associated factors for unfavorable prognosis in neonates with septic shock

Neonatal septic shock represents a life-threatening complication of neonatal sepsis associated with substantial in-hospital mortality. Conventional diagnostic criteria only detect shock at the decompensated stage, which inevitably delays optimal treatment. This study aimed to identify independent predictors associated with adverse outcomes in neonates with septic shock and evaluate the predictive performance of combined early laboratory biomarkers and point-of-care cardiac ultrasound parameters.

A single-center retrospective cohort study was performed on 98 neonates diagnosed with septic shock admitted to the Neonatal Intensive Care Unit of Chengdu Women's and Children's Central Hospital from January 2024 to December 2025. Patients were stratified into a favorable prognosis group (n=67) and an unfavorable prognosis group (n=31) based on discharge outcomes. Perinatal baseline data, initial laboratory tests and bedside critical cardiac ultrasound measurements were compared between groups. Univariate analyses followed by backward stepwise binary logistic regression were used to screen independent prognostic predictors, and receiver operating characteristic (ROC) curves were constructed to quantify predictive efficacy.

Compared with patients with favorable outcomes, neonates with poor prognosis exhibited lower gestational age, birth weight and Apgar scores, elevated serum interleukin-6 (IL-6), myoglobin (MYO) and high-sensitivity cardiac troponin I; reduced serum albumin and calcium, as well as increased serum potassium. Cardiac ultrasound revealed significantly decreased velocity-time integral (VTI), cardiac output (CO) and tricuspid annular plane systolic excursion (TAPSE) in the unfavorable prognosis group (all P<0.05). Multivariate logistic regression identified gestational age, VTI and TAPSE as independent protective factors, while elevated IL-6 served as an independent predictor for adverse prognosis (P<0.05). ROC analysis demonstrated that TAPSE yielded the highest area under the curve (AUC =0.857), followed by VTI (AUC =0.785), gestational age (AUC =0.739) and IL-6 (AUC =0.716). The combined four-marker model achieved an AUC of 0.905, which outperformed all individual indicators.

Lower gestational age, elevated IL-6, and reduced VTI and TAPSE independently associated with poor prognosis in neonates with septic shock. Integrated assessment combining perinatal characteristics, admission inflammatory biomarkers and bedside cardiac ultrasound enables identification of high-risk infants, and may facilitate risk stratification for neonatal septic shock.