A composite inflammatory-renal prognostic score predicts in-hospital mortality in older adults with sepsis

Sepsis remains a leading cause of mortality among older hospitalized adults. Readily available biomarkers may improve early risk stratification in this vulnerable population. We evaluated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), and estimated glomerular filtration rate (eGFR), and developed a composite score (NCe) integrating these parameters. This retrospective cohort study included 846 patients aged ≥75 years hospitalized with sepsis or septic shock within the Report-AGE project. NLR, CAR, and eGFR were assessed at admission. Multivariable Cox proportional hazards models were adjusted for age, sex, transaminases, RDW-CV, Charlson Comorbidity Index, polypharmacy, and functional impairment. Overall, 258 patients (30.5%) died during hospitalization. Non-survivors had higher NLR and CAR values and lower eGFR than survivors. The highest NLR tertile was independently associated with mortality, whereas CAR showed a weaker association. The NCe score demonstrated a graded increase in mortality risk across categories, with Kaplan-Meier analyses showing progressively lower survival as the score increased. In conclusion, routine inflammatory and renal biomarkers are associated with mortality in older adults with sepsis. Their integration into the NCe score may provide a simple and widely accessible approach to mortality risk stratification in older adults with sepsis, warranting further prospective validation.