Factors associated with mortality in pediatric septic shock in Thai children with long-term survival analysis post-hospital discharge: a nationwide study 2015–2022

Septic shock remains a leading cause of preventable childhood death, yet contemporary population‑level data on early and post‑discharge outcomes in low‑ and middle‑income settings are scarce. We analyzed nationwide trends and risk factors for in‑hospital and long‑term mortality among Thai children with septic shock. This was a retrospective national study encompassing 18,697 children aged 1 month to under 18 years old hospitalized with septic shock in Thailand from January 2015 to December 2022. In-hospital mortality occurred in 5,375 children (28.7%). Acute respiratory failure was the strongest factor associated with in-hospital death (aOR 15.51, 95% CI 13.24-18.16; p < 0.001). Additionally, neoplasm was the most potent co-morbidity associated with mortality (aOR 2.43, 95% CI 2.12-2.78; p < 0.001). Of 13,322 hospital survivors, 2,155 (16.2%) died during follow‑up. Post‑discharge mortality was highest in preschool children and was also associated with neoplasms (aHR 4.56, 95% CI 4.05-5.13; p < 0.001). Nationwide data show that more than one in four Thai children with septic shock die in hospital, and one in eight additional deaths occur after discharge. Respiratory failure and malignant disease markedly heighten risk. Timely, guideline-concordant resuscitation, proactive management of high-risk comorbidities, and structured post-ICU follow-up are urgent priorities to improve both early and long-term survival.