A Novel Composite Bioscore Integrating Biomarkers, Clinical Scores, and Comorbidity Indices for Prognostic Stratification in Sepsis

George Țocu,1,2 Raul Mihailov,3 Valerii Luțenco,3 Florentin Dimofte,3 Bogdan Ioan Ștefănescu,3 Elena Niculeț,4 Oana Mariana Mihailov,5 Lavinia Țocu,6 Loredana Stavăr Matei5 1Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania; 2Clinical Department of Medical Laboratory Analysis, “Sf. Apostol Andrei” County Emergency Clinical Hospital, Galați, 800578, Romania; 3Department of Clinical Surgery, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania; 4Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania; 5Department of Clinical Medicine, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania; 6Department of Clinical Cardiology, “Sf. Apostol Andrei” County Emergency Clinical Hospital, Galați, 800578, RomaniaCorrespondence: Bogdan Ioan Ștefănescu, Department of Clinical Surgery, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galați, 800008, Romania, Email [email protected] Lavinia Țocu, Department of Clinical Cardiology, “Sf. Apostol Andrei” County Emergency Clinical Hospital, Galați, 800578, Romania, Email [email protected]: Risk stratification in sepsis remains a major clinical challenge in hospital settings, where timely recognition of disease progression can critically influence outcomes. Traditional scoring systems, such as SOFA and APACHE II, are frequently applied but are limited by their complexity and inconsistent predictive accuracy. Integrating biological markers with clinical scores may enhance the early identification of patients with an unfavorable prognosis.Objective: The objective of this investigation was to determine the prognostic performance of two composite scoring systems, BIO-S and BIO-SC, in predicting 28-day mortality among patients with sepsis or septic shock.Methods: We conducted a retrospective single-center study including 125 adult surgical patients with sepsis or septic shock. BIO-S was calculated using procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), INR, and SOFA score, whereas BIO-SC extended this model by incorporating the Charlson Comorbidity Index (CCI). Both bioscores were calculated at admission and analyzed in relation to 28-day mortality and discharge status.Results: Among the 125 patients included, 28-day all-cause mortality was 36% (n = 45). The BIO-SC score achieved the highest predictive accuracy for 28-day mortality (AUC = 0.942), surpassing BIO-S (AUC = 0.930), SOFA (AUC = 0.928), and APACHE II (AUC = 0.918). Both bioscores correlated strongly with discharge outcomes and were independent predictors of 28-day mortality (p < 0.001).Conclusion: Integrating inflammatory biomarkers, organ dysfunction, and comorbidity burden into composite prognostic models such as BIO-S and BIO-SC significantly improves early mortality risk assessment and outcome prediction in sepsis, although external validation remains necessary.Keywords: sepsis, septic shock, bioscore, biomarker, prognostic, risk stratification