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目的:基于衰弱综合征建立老年脓毒症患者180 d病死率的预测评分模型〔老年脓毒症评分（ESS）〕。方法:采用前瞻性观察性研究方法，选择2018年1月1日至12月31日在南部战区总医院重症医学科住院的、年龄≥60岁的老年脓毒症患者，记录患者相关资料，包括性别、年龄、体重指数（BMI）、肿瘤、合并症指数（CCI）、日常生活活动能力（ADL）、工具性日常生活活动能力（IADL）、简易精神状态量表（MMSE）、老年抑郁量表（GDS）、临床衰弱分级（CFS）、序贯器官衰竭评分（SOFA）、格拉斯哥昏迷评分（GCS）、急性生理学与慢性健康状况评分（APACHEⅡ、APACHEⅣ）、改良营养评分（MNS）、多重耐药性（MDR）、机械通气（MV）、连续性肾脏替代治疗（CRRT）、姑息治疗19项自变量进行单因素分析，将连续自变量进行分类变量转换后，对危险因素进行多因素二元回归分析，筛选影响老年脓毒症患者180 d病死率的独立危险因素，从而建立180 d病死率的预测评分，并与CFS、SOFA、GCS、APACHEⅡ、APACHEⅣ、MNS 6种评分比较对患者病死率的辨别力。结果:共纳入257例老年脓毒症患者，180 d病死率为60.7%。单因素分析显示，年龄、肿瘤、CCI、ADL、IADL、MMSE、CFS、SOFA、GCS、APACHEⅡ、APACHEⅣ、MNS、MDR、MV、CRRT、姑息治疗为影响老年脓毒症患者180 d病死率的危险因素〔年龄：优势比（n OR）＝1.027，95%可信区间（95%n CI）为1.005～1.050，n P＝0.018；肿瘤：n OR＝2.001，95%n CI为1.022～3.920，n P＝0.043；CCI：n OR＝1.193，95%n CI为1.064～1.339，n P＝0.003；ADL：n OR＝0.851，95%n CI为0.772～0.940，n P＝0.001；IADL：n OR＝0.894，95%n CI为0.826～0.967，n P＝0.005；MMSE：n OR＝0.962，95%n CI为0.937～0.988，n P＝0.004；CFS：n OR＝1.303，95%n CI为1.089～1.558，n P＝0.004；SOFA：n OR＝1.112，95%n CI为1.038～1.191，n P＝0.003；GCS：n OR＝0.918，95%n CI为0.863～0.977，n P＝0.007；APACHEⅡ：n OR＝1.098，95%n CI为1.053～1.145，n P<0.001；APACHEⅣ：n OR＝1.032，95%n CI为1.020～1.044，n P<0.001；MNS：n OR＝1.315，95%n CI为1.159～1.493，n P<0.001；MDR：n OR＝2.029，95%n CI为1.197～3.437，n P＝0.009；MV：n OR＝6.408，95%n CI为3.480～11.798，n P<0.001；CRRT：n OR＝2.744，95%n CI为1.529～4.923，n P＝0.001；姑息治疗：n OR＝5.760，95%n CI为2.177～15.245，n P<0.001〕。二元回归分析显示，CFS分层（n OR＝1.934，95%n CI为1.267～2.953，n P＝0.002）、MV（n OR＝4.531，95%n CI为2.376～8.644，n P<0.001）、CRRT（n OR＝2.471，95%n CI为1.285～4.752，n P＝0.007）、姑息治疗（n OR＝6.169，95%n CI为2.173～17.515，n P＝0.001）是影响老年脓毒症患者180 d病死率的独立危险因素。建立老年脓毒症患者180 d病死率的预测评分“ESS＝0.660×CFS分层+1.511×MV+0.905×CRRT+1.820×姑息治疗”。ESS预测老年脓毒症患者180 d病死率的受试者工作特性曲线（ROC曲线）下面积（AUC）为0.785，95%n CI为0.730～0.834，n P2.2分时，其敏感度为78.9%，特异度为70.3%，阳性预测值为80.4%，阴性预测值为68.3%。简化ESS＝0.5×CFS分层+1.5×MV+1×CRRT+2×姑息治疗，简化ESS预测老年脓毒症患者180 d病死率的AUC为0.784，95%n CI为0.729～0.833，n P2.0分时，其敏感度为76.9%，特异度为70.3%，阳性预测值为80.0%，阴性预测值为66.4%。与CFS、SOFA、GCS、APACHEⅡ、APACHEⅣ、MNS 6种评分比较，ESS对老年脓毒症患者180 d病死率的辨别力更显著（AUC：0.785比0.607、0.607、0.600、0.664、0.702、0.657，95%n CI：0.730～0.734比0.537～0.678、0.537～0.677、0.529～0.671、0.598～0.730、0.638～0.766、0.590～0.725，均n P<0.05）。n 结论:CFS、MV、CRRT和姑息治疗是影响老年脓毒症患者180 d病死率的独立危险因素，根据上述危险因素建立的预测评分ESS评估能力良好，可作为老年脓毒症患者预后判断和分类救治的参考及评估工具。“,”Objective:To establish a 180-day mortality predictive score based on frailty syndrome in elderly sepsis patients [elderly sepsis score (ESS)].Methods:A prospective study for sepsis patients aged 60 years and above who were admitted to a medical intensive care unit of the General Hospital of Southern Theatre Command from January 1st, 2018 to December 31st, 2018 was conducted. Univariate analysis was performed on 19 independent variables including gender, age, body mass index (BMI), tumor, charlson comorbidity index (CCI), activity of daily living (ADL), instrumental activity of daily living (IADL), mini-mental state examination (MMSE), geriatric depression scale (GDS), clinical frail scale (CFS), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS), acute physiology and chronic health evaluation (APACHEⅡ, APACHEⅣ), modified NUTRIC score (MNS), multiple drug resistance (MDR), mechanical ventilation (MV), continuous renal replacement therapy (CRRT) and palliative care. Continuous independent variables were converted into classified variables. Multivariate binary regression analysis of risk factors was conducted to screen independent risk factors which affecting 180-day mortality in elderly sepsis patients. Then a 180-day mortality predictive score was established, and the discrimination of the mortality of patients using CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS scores were compared.Results:A total of 257 patients were enrolled, with a 180-day mortality of 60.7%. Univariate analysis showed that age, tumor, CCI, ADL, IADL, MMSE, CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS, MDR, MV, CRRT, palliative care were risk factors of 180-day mortality in elderly sepsis patients [age: odds ratio (n OR) = 1.027, 95% confidence interval (95%n CI) was 1.005-1.050, n P = 0.018; tumor: n OR =2.001, 95%n CI was 1.022-3.920, n P = 0.043; CCI: n OR = 1.193, 95%n CI was 1.064-1.339, n P = 0.003; ADL: n OR = 0.851, 95%n CI was 0.772-0.940, n P = 0.001; IADL: n OR = 0.894, 95%n CI was 0.826-0.967, n P = 0.005; MMSE: n OR = 0.962, 95%n CI was 0.937-0.988, n P = 0.004; CFS: n OR = 1.303, 95%n CI was 1.089-1.558,n P = 0.004; SOFA: n OR = 1.112, 95%n CI was 1.038-1.191, n P = 0.003; GCS: n OR = 0.918, 95%n CI was 0.863-0.977, n P = 0.007; APACHEⅡ: n OR = 1.098, 95%n CI was 1.053-1.145, n P < 0.001; APACHEⅣ: n OR = 1.032, 95%n CI was 1.020-1.044, n P < 0.001; MNS: n OR = 1.315, 95%n CI was 1.159-1.493, n P < 0.001; MDR: n OR = 2.029, 95%n CI was 1.197-3.437, n P = 0.009; MV: n OR = 6.408, 95%n CI was 3.480-11.798, n P < 0.001, CRRT: n OR = 2.744, 95%n CI was 1.529-4.923, n P = 0.001, palliative care: n OR = 5.760, 95%n CI was 2.177-15.245, n P < 0.001]. By binary regression analysis, CFS stratification ( n OR = 1.934, 95%n CI was 1.267-2.953, n P = 0.002), MV (n OR = 4.531, 95%n CI was 2.376-8.644, n P < 0.001), CRRT ( n OR = 2.471, 95%n CI was 1.285-4.752, n P = 0.007), palliative care (n OR = 6.169, 95%n CI was 2.173-17.515, n P = 0.001) were independent risk factors of 180-day mortality in elderly patients with sepsis. The model of “ESS = 0.660×CFS stratification+1.511×MV+0.905×CRRT+1.820×palliative care” was established. Receiver operating characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) for predicting 180-day mortality by ESS was 0.785 (95% n CI was 0.730-0.834, n P < 0.001). When the best cut-off value was 2.2 points, its sensitivity was 78.9%, specificity was 70.3%, the positive predictive value was 80.4%, and the negative predictive value was 68.3%. Simplified ESS was defined as “0.5×CFS stratification+1.5×MV+1×CRRT+2×palliative care”. ROC curve analysis showed that AUC for predicting 180-day mortality by simplified ESS was 0.784 (95% n CI was 0.729-0.833, n P < 0.001). When the best cut-off value was 2.0 points, sensitivity was 76.9%, specificity was 70.3%, the positive predictive value was 80.0%, and the negative predictive value was 66.4%. Compared with CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ and MNS, ESS had a significant difference in discriminating 180-day mortality in elderly patients with sepsis (AUC was 0.785 vs. 0.607, 0.607, 0.600, 0.664, 0.702, 0.657, 95% n CI: 0.730-0.734 vs. 0.537-0.678, 0.537-0.677, 0.529-0.671, 0.598-0.730, 0.638-0.766, 0.590-0.725, all n P < 0.05).n Conclusions:CFS, MV, CRRT, and palliative care are independent risk factors of 180-day mortality in elderly patients with sepsis. We established ESS based on these risk factors. The ESS model has good discrimination and can be used as a reference and assessment tool for prediction and treatment guidance in elderly patients with sepsis.