Risk factors for poor prognosis in neonatal sepsis: a systematic review and meta-analysis

ObjectiveTo synthesize previous research findings through systematic review and meta-analysis and to evaluate risk factors associated with poor prognosis in neonatal sepsis, thereby providing additional evidence for early clinical risk assessment.MethodsAccording to the study objectives, population, and study design, the inclusion criteria, exclusion criteria, and detailed search strategy were established. Eight databases were searched, including PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Chinese Science and Technology Journals Database, and the Chinese Biomedical Literature Database (CBM), from database inception to January 21, 2026. The specific coverage periods were as follows: PubMed (1946 to January 21, 2026), Embase (1947 to January 21, 2026), the Cochrane Library (1992 to January 21, 2026), Web of Science (1900 to January 21, 2026), CNKI (1915 to January 21, 2026), VIP Chinese Science and Technology Journals Database (1989 to January 21, 2026), CBM (1994 to January 21, 2026), and Wanfang Data (1998 to January 21, 2026). Studies meeting the inclusion criteria were selected. Study selection and data extraction were independently performed by two reviewers. Methodological quality was assessed using the Newcastle-Ottawa Scale, and statistical analyses were conducted using RevMan 5.4.ResultsA total of 26 studies were included. The main independent risk factors for poor prognosis in neonatal sepsis were as follows: ① elevated interleukin-6 [OR = 1.97, p < 0.001]; ② elevated procalcitonin [OR = 1.59, p < 0.001]; ③ thrombocytopenia [OR = 2.47, p = 0.020]; ④ elevated C-reactive protein [OR = 2.04, p = 0.003]; ⑤ leukopenia [OR = 2.90, p = 0.001]; ⑥ elevated lactate [OR = 2.18, p = 0.005]; ⑦ Gram-negative bacterial infection [OR = 5.37, p = 0.002]; and ⑧ decreased albumin [OR = 5.77, p = 0.001].ConclusionElevated inflammatory biomarkers, hematologic abnormalities, hyperlactatemia, hypoalbuminemia, and Gram-negative bacterial infection are important indicators of poor prognosis in neonatal sepsis. Early recognition of these factors and timely intervention may improve clinical outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261290404, CRD420261290404.