Evaluating Predisposition, Infection, Response, and Organ Dysfunction, Acute Physiology and Chronic Health...

Sepsis remains a leading cause of mortality in older adults, whose age-related immune dysfunction, multimorbidity, and frailty complicate both diagnosis and prognostication. Standard scoring systems Predisposition, Infection, Response, and Organ dysfunction (PIRO), Acute Physiology and Chronic Health Evaluation (APACHE), and Sequential Organ Failure Assessment (SOFA) are widely used for risk stratification but were primarily developed in mixed-age populations. Their accuracy and applicability in geriatric sepsis, where physiological reserve and inflammatory response are altered, remain uncertain. To critically review and compare the predictive validity, clinical applicability, and limitations of PIRO, APACHE, and SOFA scoring systems in geriatric sepsis, emphasizing their strengths, weaknesses, and need for adaptation to aging physiology. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar. Studies evaluating PIRO, APACHE, or SOFA scores in adults aged ≥60 years with sepsis or septic shock were included. Data regarding discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and clinical outcomes were synthesized narratively. All three models demonstrated moderate-to-good prognostic performance (AUC 0.78-0.86). PIRO exhibited slightly superior individualized prediction by incorporating host and infection variables, whereas APACHE provided robust physiological quantification but tended to overestimate mortality in frail elders. SOFA proved effective for serial monitoring but was limited by baseline organ dysfunction. None fully accounted for frailty or functional decline. While PIRO, APACHE, and SOFA retain prognostic relevance in geriatric sepsis, their predictive precision is reduced by the heterogeneity of aging physiology. Future tools must integrate frailty, multimorbidity, and functional status to achieve truly individualized, age-adapted sepsis prognostication.