Abstract: OBJECTIVE To explore the predictive value of pleth variability index (PVI) and logistic organ dysfunction (LODS) scoring system for the prognosis of patients with sepsis. METHODSA total of 120 patients with sepsis admitted to Xianyang Central Hospital from Jul. 2022 to Jul. 2025 were selected. After corresponding treatment, patients were divided into the death group and the survival group based on their 28-day outcomes. Clinical data of the two groups were compared, and factors related to patient death were analyzed with a multivariate logistic regression model. The predictive value of PVI and LODS scores for death was assessed based on receiver operating characteristic (ROC) curves. RESULTSThe proportion of septic shock, lactate (Lac) levels, PVI values and LODS scores in the death group were all higher than those in the survival group, with statistically significant differences (P<0.05). The results of the multivariate logistic regression model showed that concurrent septic shock, elevated Lac levels, high PVI values and high LODS scores were factors related to 28-day death in patients with sepsis (P<0.05). ROC curve analysis revealed that the area under the curve (AUC) for predicting death in patients with sepsis based on PVI values and LODS scores were 0.780 and 0.860, respectively. The combined prediction yielded an AUC of 0.912, showing improved predictive efficacy compared to single predictors (Z=3.050, P=0.002. Z=2.512, P=0.010). CONCLUSIONSeptic shock, elevated Lac levels, high PVI values and high LODS scores are associated with 28-day death in patients with sepsis. Among them, PVI values and LODS scores have good clinical value in predicting patient death.