The Inflammation-Presepsin Score as a Predictor of Mortality in Elderly Sepsis Patients (≥75 Years): A Pilot Study

The clinical diagnosis and risk stratification of sepsis are particularly challenging in extremely elderly patients (≥75 years) due to atypical presentation and potential diagnostic unreliability of standard scores. This study investigated whether a composite score-presepsin combined with the Prognostic Index (iPS-PI)-offers potential prognostic utility over presepsin alone as a predictor of 28-day mortality, thereby providing a reliable tool for early clinical decision-making in this vulnerable population.

Eighty-three adult sepsis patients were prospectively examined and stratified into over 75 (n = 41) and under 75 (n = 42) age groups. Presepsin levels and total composite scores (iPS-PI) were calculated upon ICU entry. Statistical analyses, including ROC curve analysis and Cox proportional hazard models, focused on the over 75 group.

The 28-day mortality rate was 21.7% (18/83) overall (over 75 group: n = 12 [29.3%]; under 75 group: n = 6 [14.3%]). The areas under the curve (AUCs) of presepsin and iPS-PI for predicting mortality were higher (0.82) in the over 75 group than in the under 75 group. iPS-PI achieved a high AUC (0.82) in the over 75 group with a cutoff value of 2. Furthermore, in a sub-analysis focused on the over 75 group, iPS-PI (Hazard Ratio 14.22, P=0.031) was suggested as a potential independent predictor of mortality, whereas presepsin alone was not (P=0.656).

iPS-PI may be superior to presepsin alone as an independent predictor of mortality in extremely elderly sepsis patients. This finding strongly advocates for the use of iPS-PI as a time-sensitive "rule in" tool for early risk stratification, facilitating immediate and tailored aggressive therapeutic interventions by geriatric and critical care clinicians. iPS-PI also directly addresses the diagnostic challenges unique to geriatric sepsis management.