Manaporn Suksai¹

Background: Sepsis and septic shock remain major global health concerns, characterized by dysregulated host responses to infection leading to organ failure and high mortality. In Thailand, the incidence is increasing, however, evidence regarding specific risk factors for septic shock in general hospital settings remains limited.

Objective: To identify independent risk factors for septic shock among adult patients with sepsis at Sichon Hospital and to describe associated clinical characteristics and outcomes.

Materials and Methods: A retrospective cohort study was conducted using medical records of adult patients diagnosed with sepsis or septic shock at Sichon Hospital between January and December 2023. Eligible cases were identified through ICD-10 coding and screened according to predefined inclusion and exclusion criteria. Demographic, clinical, and laboratory data were analyzed to determine predictors of septic shock using multivariable logistic regression.

Results: Of the 584 screened patients, 484 met the inclusion criteria and 146, or 30.2%, developed septic shock. Multivariable logistic regression identified six independent predictors of septic shock, which are body temperature of less than 37.5℃ (OR 2.83, 95% CI 1.70 to 4.69), respiratory rate greater than 22 per minute (OR 1.79, 95% CI 1.10 to 2.92), activated partial thromboplastin time (aPTT) greater than 29.9 seconds (OR 2.06, 95% CI 1.27 to 3.36), creatinine level greater than 1.25 mg/dL (OR 2.30, 95% CI 1.39 to 3.79), albumin of less than 3.7 g/dL (OR 2.26, 95% CI 1.37 to 3.72), and bilirubin greater than 0.92 mg/dL (OR 2.51, 95% CI 1.51 to 4.18). Hypertension (OR 0.54, 95% CI 0.32 to 0.91) and positive hemoculture (OR 0.46, 95% CI 0.28 to 0.76) were inversely associated. The model demonstrated good discrimination (AUC 0.804).

Conclusion: About one-third of septic patients developed shock. Six readily available parameters, body temperature, respiratory rate, serum creatinine, aPTT, albumin, and total bilirubin, independently predicted septic shock, indicating early multi-organ dysfunction. In contrast, hypertension and positive blood cultures were inversely associated, reflecting earlier recognition and source control. Routine, low-cost clinical and laboratory data may thus support early risk stratification and timely management, especially in resource-limited settings.

Received 4 July 2025 | Revised 17 October 2025 | Accepted 24 October 2025

DOI: 10.35755/jmedassocthai.2025.12.986-997-03225