Retrospective Thai Cohort Links Phoenix Score to Pediatric Sepsis Mortality

The maximum Phoenix Sepsis Score recorded during the first 24 hours was the strongest independent prognostic factor for death in a retrospective study of immunocompromised children with sepsis and septic shock treated at a single Thai referral center. Researchers at Srinagarind Hospital, Khon Kaen University, analyzed 92 patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit between 2018 and 2023. Thirty-four patients died, corresponding to a mortality proportion of 37%.

The cohort included children with impaired immune systems and serious infection requiring intensive care. Malignancy was the most common underlying condition, accounting for 56.5% of cases, and 76.1% of the patients had septic shock. Sepsis and septic shock were classified using the 2024 Phoenix Sepsis Score criteria.

The researchers used multivariate analysis to identify factors associated with mortality and receiver operating characteristic curve analysis to assess the score’s ability to distinguish survivors from nonsurvivors. For every one-point increase in the maximum score during the first 24 hours, the adjusted odds of death increased substantially. The study reported an adjusted odds ratio of 8.20 per point, with a 95% confidence interval of 1.35–49.69 and a p-value of 0.022.

This was the strongest independent prognostic association identified in the analysis. The confidence interval was wide, indicating substantial uncertainty around the estimated size of the association, an important limitation given the retrospective design and cohort size of 92 patients. The investigators also explored a Phoenix Sepsis Score threshold of 8 or higher.

These values describe performance in the study population only. The researchers characterized the threshold as exploratory, and their results do not establish that a score of 8 can be applied as a universal clinical rule or that the score itself causes changes in outcomes. The findings support further evaluation of the Phoenix Sepsis Score as a prognostic marker in immunocompromised children with sepsis and septic shock, but external validation is required.

Because the study was retrospective and confined to one pediatric intensive care unit in Thailand, the results do not establish performance in other hospitals, patient populations or healthcare settings. The clearest supported conclusion is that higher maximum Phoenix Sepsis Scores were strongly associated with mortality in this high-risk cohort, while the proposed cutoff of 8 remains an exploratory finding awaiting validation in independent populations.

Subject of Research: Prognostic performance of the Phoenix Sepsis Score in immunocompromised children with sepsis and septic shock

Article Title: Phoenix Sepsis Score as a prognostic tool for mortality in immunocompromised children with sepsis and septic shock: a six-year study from a Thai referral center

Article References: Menorath, P., Niamsanit, S., Nanthavongsa, S., Uppala, R., Sitthikarnkha, P., & Sriruengrat, D. (2026). Phoenix Sepsis Score as a prognostic tool for mortality in immunocompromised children with sepsis and septic shock: a six-year study from a Thai referral center. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14456-3

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14456-3

Keywords: Phoenix Sepsis Score, pediatric sepsis, septic shock, immunocompromised children, mortality prediction, prognosis, pediatric intensive care, Thailand, retrospective cohort, risk stratification, Phoenix, Sepsis