Prognostic Value of the Albumin-to-Prealbumin Ratio in Elderly Patients with Sepsis

Background: Serum albumin and prealbumin are increasingly recognized as biomarkers of inflammation rather than nutritional status. Because prealbumin responds more rapidly to acute inflammatory and catabolic stress than albumin, the albumin-to-prealbumin ratio (APR) may better reflect inflammatory burden. However, its prognostic significance in elderly patients with sepsis remains unclear. Methods: This single-center retrospective observational study included 84 patients aged ≥75 years hospitalized with sepsis between April 2023 and March 2024. APR was calculated using serum albumin and prealbumin levels at admission, and patients were categorized into low- and high-APR groups based on the median value. The primary outcome was 28-day mortality. Multivariable logistic regression analysis was performed to evaluate the independent association between APR and 28-day mortality after adjustment for the Sequential Organ Failure Assessment score, maximum serum lactate level, and Mini Nutritional Assessment–Short Form. Subgroup analyses were conducted according to median serum albumin level (