ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2025.
Volume 14.
Number 3: 663-668 P-ISSN.
E-ISSN: 2528-6641
A study of the prognostic value of age shock index combined with rapid sequential organ failure score in assessing sepsis Lv Lukai1*.
Zhong Zhitao1.
Fan Mingyan1.
Li Lei1
ABSTRACT
Department of Emergency.
The Fourth PeopleAos Hospital of Zigong City.
Sichuan.
Zigong.
China.
*Corresponding author:
Lv Lukai.
Department of Emergency.
The Fourth PeopleAos Hospital of Zigong City.
Sichuan.
Zigong.
China.
m15228624536@163.
Received: 2025-07-10 Accepted: 2025-09-14 Published: 2025-10-16 Introduction: This study addresses the high incidence, mortality, and healthcare burden of sepsis by evaluating the prognostic value of combining the Age Shock Index (Age SI) with the quick Sequential Organ Failure Assessment .
SOFA) score in predicting outcomes of septic patients.
Method: A retrospective analysis was conducted involving 316 sepsis patients admitted to the ICU of the Fourth PeopleAos Hospital of Zigong City.
Sichuan Province, between December 2022 and December 2024.
Participants were categorized into survival .
= .
and nonAasurvival .
= .
Statistical analyses were performed using SPSS 26.
0 and R software to compare clinical indicators between groups.
Binary logistic regression was used to identify independent risk factors, while ROC curves, a nomogram model, and Bootstrap internal validation were employed to evaluate predictive performance.
Results: The nonAasurvival group had significantly higher values in age.
CCI score, lactate level.
SOFA score.
Age SI, and APACHE II score (P < 0.
, along with lower systolic and mean arterial pressures (P < 0.
Multivariate analysis confirmed age.
CCI score, lactate, qSOFA score, and Age SI as independent risk factors.
The ROC analysis demonstrated that the combination of Age SI and qSOFA yielded the highest predictive accuracy (AUC = 0.
832, sensitivity = 0.
783, specificity = 0.
The nomogram model achieved a C-index of 0.
832, and internal validation showed an accuracy of 74.
Conclusion: the combination of Age SI and qSOFA scores serve as an effective tool for predicting 28-day mortality in sepsis patients and may support clinical decision-making.
Keywords: age shock index, disease severity evaluation, prognostic assessment, sepsis, survival rate.
Cite This Article: Lukai.
Zhitao.
Mingyan.
Lei.
A study of the prognostic value of age shock index combined with rapid sequential organ failure score in assessing sepsis.
Bali Medical Journal 14.
: 663-668.
DOI: 10.
15562/bmj.
INTRODUCTION
Sepsis is a dysregulated immune response to infection characterized by high incidence and mortality, with approximately 19 million cases and 6 million deaths reported globally each 1Ae5 Its pathophysiology involves dyscontrolled inflammation, immune dysfunction, coagulation abnormalities, and multiple organ dysfunction.
6Ae10 Despite advances in treatment strategies such as optimized antibiotic therapy and immunomodulation11Ae15, mortality remains high, underscoring the need for more accurate prognostic tools.
Currently used clinical scoring systems such as SOFA and qSOFA have limitations including low sensitivity or dependence on laboratory parameters16Ae20, while biomarkers are often influenced by individual variability.
21,22
Studies suggest that combining qSOFA with other indicators .
, lactate or oxygenation inde.
can improve predictive performance.
23Ae27 The Age Shock Index (Age SI), which integrates age and hemodynamic parameters, has demonstrated good prognostic value in critically ill patients.
28Ae30 This study proposes a combined model of Age SI and qSOFA to overcome the limitations of single-parameter assessment.
Through a retrospective analysis of 316 sepsis patients, we evaluated the predictive ability of this combination for 28-day mortality, offering a more rapid and accurate prognostic approach for clinical 26 Previous studies have shown that the qSOFA score has low predictive effect.
Therefore, this study aimed to evaluate the prognostic value of combining the Age Shock Index (Age SI) with the quick Open Bali Medical access:Journal 14.
: 663-668 | doi: 10.
15562/bmj.
Sequential Organ Failure Assessment .
SOFA) score in predicting outcomes of septic patients.
METHODS
This study employed a retrospective design and was approved by the Ethics Committee of Zigong Fourth PeopleAos Hospital in Sichuan Province .
ith waiver of informed consen.
A total of 621 sepsis patients admitted to the ICU between December 2022 and December 2024 were initially screened.
Based on the Sepsis 3.
diagnostic criteria .
onfirmed infection and SOFA score Ou .
, 316 eligible patients .
males and 121 female.
were Inclusion criteria were: age Ou 18 years.
ICU stay Ou 24 hours, and complete clinical Exclusion criteria comprised: death
ORIGINAL ARTICLE
within 24 hours, presence of end-stage chronic or immunodeficiency diseases, and pregnancy.
All data were de-identified prior to analysis.
A total of 316 patients were ultimately included in the clinical data analysis.
Based on 28-day mortality, the patients were divided into a survival group .
and a death group .
This study analyzed data from eligible participants in both the experimental and control groups, including demographic parameters such as age, gender, body mass index (BMI).
Charlson Comorbidity Index (CCI) score, heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, renal replacement therapy status, vasoactive agent use, mechanical ventilation status, lactate levels, human serum albumin, white blood cell count, lymphocyte count, procalcitonin (PCT).
C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine clearance rate.
SOFA score, qSOFA score.
Age SI score, and APACHE II score.
Statistical analysis was performed using SPSSAU to compare differences between the two groups in terms of Table 1.
general demographic characteristics, vital signs upon ICU admission, laboratory parameters, and relevant treatment Binary logistic regression analysis was conducted on these indicators to identify independent risk factors affecting the prognosis of sepsis patients.
Receiver operating characteristic (ROC) curves were applied, and the area under the curve (AUC) was calculated to further determine sensitivity, specificity, and cutoff The predictive value of combining age, shock index (SI), and qSOFA score for the prognosis of sepsis patients was analyzed, with a p-value < 0.
05 considered statistically significant.
A nomogram for the combined Age-SI qSOFA diagnostic model was constructed, and calibration curves were used to evaluate the modelAos goodness-of-fit.
Statistical analysis was performed using R language.
Internal validation of the model was conducted via the bootstrap method to assess its predictive performance.
The C-statistic (C-inde.
and the p-value from the HosmerAeLemeshow (HL) goodness-offit test were computed based on repeated Analysis of Baseline Characteristics Between the Two Groups Variables Survivor Group (N=.
Non-survivor Group (N=.
Age .
, .
edian: Q1.
Gender, .
, %) Man Female BMI, .
edian: Q1.
CCI Score .
eanASD) <0.
94A1.
35A2.
Note: BMI, body mass index.
CCI.
Charlson Comorbidity Index Table 2.
A comparison of age, gender.
BMI, and CCI scores between the two groups is presented in Table 1.
The non-survivor group had significantly higher age and CCI scores compared to the survivor group (P < 0.
, while no significant differences were observed in gender or BMI between the groups (P > 0.
comparison of heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure between the two groups is presented in Table 2.
No significant differences were observed in respiratory rate or diastolic blood pressure between the groups (P > The heart rate in the non-survivor group was significantly higher than that in the survival group (P < 0.
Conversely, systolic blood pressure and mean arterial pressure were significantly lower in the non-survivor group compared to the survivor group (P < 0.
A chi-square test was employed to compare the differences between the two treatment approaches, with the results presented in Table 3.
Significant differences were observed between the two groups of patients in terms of whether renal replacement therapy was performed, whether vasoactive drugs were administered, and whether mechanical ventilation was received (P < 0.
The non-survivor group showed significantly higher proportions of renal replacement therapy, vasoactive drug use, and mechanical ventilation compared to the survivor group (P < 0.
Comparisons of albumin, serum creatinine, blood urea nitrogen, arterial lactate content, white blood cell count.
Comparison of Vital Signs Between the Two Groups Variables Heart rate, .
edian: Q1.
Respiratory rate, .
eanASD) Survivor Group (N=.
Non-survivor Group (N=.
79A9.
Systolic blood pressure (SBP), .
, .
edian: Q1.
Diastolic blood pressure (DBP), .
, .
edian: Q1.
Mean arterial pressure (MAP), .
, .
eanASD) 63A20.
P value RESULTS P value 79A9.
<0.
<0.
61A21.
Bali Medical Journal 2025.
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ORIGINAL ARTICLE
Table 3.
Comparison of Treatment Approaches Between the Two Groups Variables Survivor Group (N=.
Non-survivor Group (N=.
Whether to undergo renal replacement therapy, .
, %) Yes Whether to use vasoactive drugs, .
, %) Yes Whether to receive mechanical ventilation, .
, %) Yes Table 4.
<0.
<0.
Comparison of Laboratory Parameters Between the Two Groups Variable Lactate, .
mol/L), .
edian: Q1.
Survival Group (N=.
Non-survivor (N=.
79A6.
97A5.
41A97.
71A126.
77A9.
12A9.
Albumin, .
/L), .
eanASD) P value <0.
White Blood Cell Count, .
/L), .
edian: Q1.
Lymphocyte Count, .
/L), .
edian: Q1.
Procalcitonin, (Ng/mL), .
edian: Q1.
CRP, .
g/L), .
edian: Q1.
Serum creatinine, .
ol/L), .
eanASD) Blood urea nitrogen (BUN), .
mol/L), .
eanASD) Table 5.
P value Comparison of Disease Severity Between the Two Groups Variable SOFA, .
edian: Q1.
Survivor Group (N=.
Non-survivor Group (N=.
qSOFA, .
edian: Q1.
<0.
Age SI, .
edian: Q1.
APACHE II, .
edian: Q1.
P value <0.
<0.
<0.
Note: SOFA.
Sequential Organ Failure Assessment.
qSOFA, quick Sequential Organ Failure Assessment.
Age SI.
Age Shock Index.
APACHE II.
Acute Physiology and Chronic Health Evaluation II.
lymphocyte count, procalcitonin, and C-reactive protein were conducted between the two groups.
The results, as shown in Table 4, indicated that arterial lactate and serum creatinine levels in the mortality group were significantly higher than those in the survival group (P < 0.
The differences in SOFA, qSOFA.
Age SI, and APACHE II scores between the two groups were compared.
As shown in Table 5, the non-survivor group had significantly higher SOFA, qSOFA.
Age SI, and APACHE II scores compared to the survivor group (P < 0.
Currently, a variety of combined diagnostic indicators have been developed in clinical practice for the early diagnosis and prognosis assessment of sepsis, such as combining qSOFA with procalcitonin, lactate, or mean arterial pressure.
This study compared the Bali Medical Journal 2025.
: 663-668 | doi: 10.
15562/bmj.
diagnostic efficacy of the combined Age SI qSOFA with LqSOFA.
PqSOFA, and MqSOFA, analyzing differences among various combined diagnostic methods in predicting sepsis severity and prognosis to determine which approach possesses the highest diagnostic efficacy in clinical The aim is to enable earlier and more accurate identification of sepsis patients, thereby improving clinical outcomes.
ORIGINAL ARTICLE
Table 6.
Diagnostic Performance Analysis of the Combined Model Indicators AUC Cut-off value Sensitivity (%) Specificity (%) PqSOFA LqSOFA MqSOFA Age SI qSOFA Note: PqSOFA, procalcitonin-combined quick Sequential Organ Failure Assessment.
LqSOFA, lactate-enhanced quick Sequential Organ Failure Assessment.
MqSOFA, mean arterial pressure-combined quick Sequential Organ Failure Assessment.
Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic efficacy of the combined Age SI qSOFA versus PqSOFA.
LqSOFA, and MqSOFA.
The results, presented in Table 6, demonstrate that the combined diagnostic model of Age SI and qSOFA is superior to other combined models, with an AUC of 832, a sensitivity of 78.
3%, and a specificity DISCUSSION Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, which can rapidly progress to septic shock or even multiple organ dysfunction syndrome (MODS) within a short period.
As a critical condition in emergency and critical care medicine, sepsis has consistently been a major focus in clinical practice.
In recent years, research emphasis has shifted toward prevention and early diagnosis.
Domestic scholars have also been actively exploring and optimizing early management strategies for sepsis.
The 2020 Chinese Emergency Expert Consensus on Early Prevention and Blockage of Sepsis31 Emphasizes the concept of Auearly prevention, early detection, and early intervention,Ay advocating for targeted examinations, laboratory tests, and interventions during the early stages of sepsis to halt its progression to multiple organ failure, thereby reducing both the incidence and mortality of sepsis.
Due to the complexity of sepsis, which involves multiple interrelated pathophysiological mechanisms, it remains a significant global health challenge despite advances in understanding and medical technology in recent years.
The annual number of sepsis patients still exceeds 300,000, with an overall mortality rate of 17%, making it a substantial global disease burden.
Early recognition of sepsis severity and timely intervention can significantly improve patient outcomes.
In recent years, increasing research has been dedicated to identifying factors influencing the severity and prognosis of sepsis patients, aiming to assist clinicians in earlier risk stratification and short-term prediction.
This enables timely and adequate treatment, effectively controlling disease progression and improving patient outcomes.
It has high morbidity and mortality rates, posing a major global health burden.
31Ae35 Early identification and intervention are crucial for improving prognosis.
36Ae38 The qSOFA score serves as a rapid screening tool and can effectively predict 28-day mortality in septic patients (OR = 6.
P < 0.
The Age SI .
ge y heart rate / systolic blood pressur.
, which integrates independent risk factors such as age, heart rate, and systolic blood pressure, also demonstrates significant predictive value (OR = 1.
= 0.
Furthermore, the SOFA score (OR = 255.
P < 0.
APACHE II score (OR = 333.
P < 0.
CCI (OR = 1.
P <
, as well as lactate levels and serum creatinine, are closely associated with sepsis severity and prognosis.
Studies have shown that combining Age SI with the qSOFA score significantly improves predictive performance (AUC = 0.
outperforming single indicators and other scoring systems with high sensitivity and specificity.
This approach aids in the early identification of high-risk patients, guides clinical intervention, and improves patient outcomes.
40,41 The qSOFA score can effectively identify sepsis patients with poor prognosis, yet it cannot be used alone in many cases of sepsis.
The 2021 International Guidelines for Management of Sepsis and Septic Shock recommend using the qSOFA score as a standalone screening tool for sepsis or septic shock.
To address this limitation, it is necessary to combine qSOFA with other indicators.
Studies have shown that when combined with other screening markers, the qSOFA score significantly improves both sensitivity and specificity, enabling better prediction of sepsis prognosis.
Research indicates that the AgeShock Index (Age SI) holds certain value in predicting sepsis prognosis.
integrating factors such as age, heart rate, and systolic blood pressure, it allows for a rapid and non-invasive assessment of disease severity and prognostic risk in 41 Moreover, it can be used in combination with other indicators to predict outcomes in sepsis patients.
For instance, combining Age SI with markers such as the neutrophil-to-lymphocyte ratio provides a more comprehensive evaluation of the patientAos condition, reducing the limitations associated with single-parameter assessments.
28,29 In this study, the combination of Age SI and qSOFA score demonstrated superior performance in predicting 28-day mortality among sepsis patients compared to using either qSOFA or Age SI alone.
Furthermore, its predictive efficacy was higher than that of SOFA score.
APACHE II score.
LqSOFA.
PqSOFA, and MqSOFA.
The AUC reached 0.
832, with a sensitivity 783 and specificity of 0.
The combination of these two indicators compensates for the low specificity of qSOFA and the oversimplification of Age SI.
A nomogram for the combined Age SI qSOFA diagnostic model was developed and internally validated.
The model showed a C-index of 0.
832, and the Hosmer-Lemeshow goodness-of-fit test yielded a p-value of 0.
4042, indicating good model consistency.
However, single-center retrospective observational study, it is limited by potential issues such as restricted data accuracy, inability to infer causality, and possible confounding The limited sample size and lack Bali Medical Journal 2025.
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ORIGINAL ARTICLE
of subgroup analysis based on disease progression also constrain in-depth interpretation of the results.
Future efforts should involve multicenter, prospective studies with expanded sample sizes that include patients from diverse healthcare Incorporating stratified analysis or causal inference methods .
uch as propensity score matchin.
would allow more accurate evaluation of the predictive performance and clinical applicability of the combined Age SI and qSOFA score.
Furthermore, it is recommended to group patients according to clinical outcomes to further explore the predictive value of this combined indicator across different prognostic states, thereby promoting the optimization and clinical application of sepsis prognostic assessment systems.
CONCLUSION
Multivariate logistic regression analysis confirmed that age.
CCI score, lactate level, qSOFA score.
SOFA score.
Age SI.
APACHE II score, as well as the use of vasoactive drugs and mechanical ventilation, are all independent risk factors affecting the 28-day survival rate of sepsis patients.
This study innovatively proposed that the combination of Age SI and qSOFA score can serve as an effective indicator for assessing sepsis prognosis, establishing a novel evaluation framework that has not yet been widely adopted.
This provides a new tool and research direction for early risk stratification and prognostic judgment in sepsis.
CONFLICT OF INTEREST
All authors of this paper declare that they have no conflicts of interest.
FUNDING
This study was supported by the project AuComparison of the Clinical Value of Different Emergency gSOFA Scores in Predicting Sepsis Prognosis,Ay funded by Grant No 22yb024.
ETHICAL STATEMENT
This study employed a retrospective design
and was approved by the Ethics Committee of Zigong Fourth PeopleAos Hospital in Sichuan Province with approval number
AUTHOR CONTRIBUTIONS
Lv Lukai-Manuscript editing and Design.
Zhong zhitao- Manuscript editing and Data acquisition.
Fan Mingyan and Li Lei- Manuscript editing and Data analysis.
REFERENCES