Objective：The current study aims to analyse the correlation between early inflammatory factor changes and severity as well as prognosis in elderly patients with sepsis. Methods：Retrospective analysis of the clinical data of 135 sepsis patients admitted to the First Affiliated Hospital of Nanjing Medical University between September 2020 and March 2022. According to age，patients were divided into the elderly group（≥ 65 years old）and the young adult group（＜65 years old）. The elderly patients（≥ 65 years old）with sepsis were divided into septic shock group and septic group according to whether they had septic shock，and divided into survival group and death group according to the 28-day mortality rate. The inflammatory factor changes were compared between the above sub- groups. The correlations between white blood cell（WBC），procalcitonin（PCT），C-reactive protein（CRP），interleukin（IL）-2，IL-4，IL-6， IL-10，tumor necrosis factor（TNF）-α，interferon（IFN）-γ，platelet（PLT），lymphocyte（Lym）and APACHE Ⅱ score in elderly patients with sepsis were analyzed by Spearman correlation analysis. ROC curve was used to compare above - mentioned indexes in the judgement of 28-day mortality rate in elderly patients with sepsis. Results：In patients with sepsis，the PLT and Lym in the elderly group were significantly lower than those in the young adult group，and APACHE Ⅱ score in the elderly group was significantly higher than that in the young adult group. In elderly patients with sepsis，the PCT，CRP，APACHE Ⅱ score in septic shock group were significantly higher than those in the septic group，and PLT in septic shock group was significantly lower than that in the septic group；and APACHE Ⅱ score in the survival group was significantly lower than that in the death group. IL-10 was positively correlated with APACHE Ⅱ score，and PLT was negatively correlated with APACHE Ⅱ score. According to ROC curve and area under the curve，the APACHE Ⅱ score alone，combination of all indicators except APACHE Ⅱ score and the combination of all indicators could predict the 28-day mortality rate of elderly patients with sepsis. Conclusion：In elderly patients with sepsis，the lower the PLT and the higher IL - 10 in the early stage，the worse the condition and prognosis of the elderly patients with sepsis. The combination of multiple indicators to predict 28-day mortality in elderly patients with sepsis has a higher accuracy than single indicator.