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

Yuichiro Shimoyama, Noriko Kadono, Osamu Umegaki Department of Anesthesiology, Osaka Medical and Pharmaceutical University, Intensive Care Unit, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, 569-8686, JapanCorrespondence: Yuichiro Shimoyama, Department of Anesthesiology, Osaka Medical and Pharmaceutical University, Intensive Care Unit, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan, Tel +81-72-683-1221, Fax +81-72-684-6547, Email shimocchiliebesfreud512@yahoo.co.jpPurpose: 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.Patients and Methods: 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.Results: 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).Conclusion: 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.Plain Language Summary: Sepsis is a life-threatening condition, particularly for elderly patients. Diagnosing and predicting outcomes in patients over age 75 years can be difficult due to atypical symptoms. This study investigated a new scoring system called the “inflammation-presepsin score combined with the Prognostic Index (iPS-PI)” to determine whether it could better predict mortality in this age group. We examined 83 sepsis patients and found that the iPS-PI score was a more accurate predictor of death within 28 days than measuring presepsin levels alone. This new scoring system could help doctors identify high-risk elderly patients earlier and start life-saving treatments sooner.Keywords: inflammation-presepsin score, iPS, presepsin, mortality, septic shock, geriatric sepsis