{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:12:27Z","timestamp":1790143947469,"version":"4.0.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). LASSO regression retained four variables with non-zero coefficients. In subsequent multivariable analysis, higher prealbumin (OR\u2009=\u20090.945, 95% CI: 0.898\u20130.994,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028) and higher systemic immune-inflammation index (SII; OR\u2009=\u20090.958, 95% CI: 0.930\u20130.992,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.025) 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\u2009=\u20093.061, 95% CI: 1.244\u20137.531,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.015). 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\u20130.939), with a sensitivity of 83.53% and a specificity of 85.41%; the bootstrap-corrected AUC 0.811 and LOOCV AUC 0.804.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1883371","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:53:58Z","timestamp":1790142838000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics and risk factors for septic shock in neonates with early-onset sepsis: a matched case\u2013control study"],"prefix":"10.3389","volume":"13","author":[{"given":"Juan","family":"Liu","sequence":"first","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhui","family":"Hu","sequence":"additional","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Li","sequence":"additional","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajia","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaojun","family":"Pan","sequence":"additional","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S140","DOI":"10.1016\/S0140-6736(26)00648-3","article-title":"The Lancet Commission on Sepsis: transforming sepsis care and outcomes","author":"Shankar-Hari","year":"2026","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"897","DOI":"10.7499\/j.issn.1008-8830.2412179","article-title":"Expert consensus on the diagnosis and treatment of common neonatal diseases in primary healthcare institutions: neonatal sepsis (2025)","volume":"27","year":"2025","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"key":"B3","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/S2213-2600(18)30063-8","article-title":"The global burden of paediatric and neonatal sepsis: a systematic review","volume":"6","author":"Fleischmann-Struzek","year":"2018","journal-title":"Lancet Respir Med."},{"key":"B4","first-page":"1770","article-title":"Neonatal sepsis","volume-title":"Lancet","author":"Shane","year":"2017"},{"key":"B5","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.pcl.2012.12.003","article-title":"Neonatal infectious diseases: evaluation of neonatal sepsis","volume":"60","author":"Camacho-Gonzalez","year":"2013","journal-title":"Pediatr Clin North Am"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1544935","DOI":"10.3389\/fmicb.2025.1544935","article-title":"Bordetella pertussis bacteremia in infants co-infected with cytomegalovirus and respiratory syncytial virus","volume":"16","author":"Sun","year":"2025","journal-title":"Front Microbiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1657655","DOI":"10.3389\/fmed.2025.1657655","article-title":"Clinical features analysis for complications in infants with late-onset group B streptococcal sepsis: a retrospective case-control study","volume":"12","author":"Geng","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1056\/NEJMra021333","article-title":"The pathophysiology and treatment of sepsis","volume":"348","author":"Hotchkiss","year":"2003","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s00134-026-08360-2","article-title":"Surviving sepsis campaign international guidelines for the management of sepsis and septic shock in children 2026","volume":"52","author":"Weiss","year":"2026","journal-title":"Intensive Care Med"},{"key":"B10","volume-title":". 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