Background Paucity of data is available on the in-hospital and 28-day prognostic value of at-admission high-sensitivity troponin T (hs-TnT) level in elderly patients with sepsis admitted to intensive care units.Methods Patients aged 65 or older with sepsis or septic shock admitted to geriatric ICU in Guangdong Provincial People's Hospital between January 2010 and December 2017 were enrolled in the study.Receiver operator characteristic (ROC) curve analysis was performed to evaluate the predictive value of hs-TnT for in-hospital mortality.Multivariate Cox survival regression was used to determine independent risk factor of hs-TnT for 28-day death.Results The in-hospital mortality was 64.4％.According to the receiver operator characteristic (ROC) curve analysis,the cut-off for predicting in-hospital death was 65.2 pg/mL.Patients with elevated hs-TnT had a higher rate of in-hospital mortality (75％ vs.53.4％,P＜0.001) and 28-day mortality (47.7％ vs.27.6％,P＜0.001).Multivariate regression showed that lg(hs-TnT) was an independent risk factor for in-hospital death (adjusted HR: 1.53,95％ CI: 1.16-2.01,P=0.03).Kaplan-Meier survival curves showed that elderly patients with at-admission hs-TnT ＞65.2 pg/mL had a worse outcome than those with hs-TnT ＜65.2 pg/mL (Log-rank test: 17.46,P=0.000).Conclusions In elderly patients with sepsis admitted to intensive care units,elevated hs-TnT level measured upon admission was associated with increased mortality rate.hs-TnT independently contributed to the prediction of 28-day mortality.