Abstract:Objective To investigate the serum levels of T-cell immunoglobulin and mucin- containing molecule-3（TIM-3），paraoxonase-1（PON-1），and growth differentiation factor-15（GDF-15）in elderly sepsis patients and their relationship with poor prognosis. Methods A total of 128 elderly sepsis patients who visited the First People's Hospital of Lianyungang between October 2022 and October 2024 were retrospectively selected as the research subjects（sepsis group）. All patients were assigned into a simple sepsis group（n=50）and a septic shock group（n=78）based on the disease severity. According to the survival status after 28 days，the patients were assigned into a survival group（n=77）and a death group（n=51）. In the same period，119 individuals who experienced physical examination were included as the healthy control group. Enzyme-linked immunosorbent assay was used to detect serum TIM-3，PON-1，and GDF-15 in sepsis group patients within 24 hours of admission and in the healthy control group on the day of physical examination.Multivariate logistic regression analysis was used to screen for influencing factors. Receiver operating characteristic（ROC）curve was plotted to analyze the predictive value of indicators for prognosis. The area under the curve（AUC）was compared using Z-test. Results The serum levels of TIM-3 and GDF-15 in sepsis group were higher than those in healthy control group，while the PON-1 was lower than that in healthy control group（P＜0.01）. The serum TIM-3 and GDF-15 in septic shock group were higher than those in normal sepsis group，and the PON-1 was lower than that in normal sepsis group（P＜0.01）. Compared with the survival group，the Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ）score，Sequential Organ Failure Assessment（SOFA）score，the level of TIM-3，and GDF-15 were higher（P＜0.05），PON-1 was lower（P＜0.05）in death group. Increased TIM- 3 and GDF-15 were independent risk factors for death in elderly sepsis patients（OR =3.167，95%CI：1.604-6.252，P=0.001；OR =2.942，95%CI：1.411-6.135，P=0.004），while increased PON-1 was a protective factor for death in elderly sepsis patients（OR =0.756，95%CI：0.631-0.905，P=0.002）. The AUC of TIM-3，PON-1，and GDF-15 alone and combined to predict death were 0.830，0.826，0.828，and 0.950，respectively. The combined AUC surpassed the individual AUC（P＜0.05）. Conclusion Serum levels of TIM-3，PON-1，and GDF-15 are factors influencing death in elderly patients with sepsis，and combined detection has high predictive value for their death risk.