Objective To explore the predictive value of quick sequential organ failure assessment (qSOFA) combined with red blood cell distribution width (RDW) for prognosis in the elderly patients with sepsis. Methods Totally 124 the elderly septic patients (≥60 years) with laboratory data, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and quick sequential organ failure assessment (qSOFA) admitted in First Affiliated Hospital of Hebei North University from June 2016 to June 2019 were enrolled in this retrospective study. According to the prognosis in 30 d after hospitalization, they were divided into the survival group (78) and the death group (46). The differences of clinical data between the two groups were compared by student′s t test, non-parametric test and Chi-square test. The influencing factors of prognosis were analyzed by Cox regression model. Kaplan-Meier curve was used to analyze the differences of prognosis among the patients with different qSOFA and RDW. The predictive value of qSOFA and RDW on prognosis were analyzed by receiver operating characteristic (ROC) curve. Results Compared with the survival group, the dead group had significantly wider RDW, higher levels of creatinine and procalcitonin, and higher points of APACHE Ⅱ and qSOFA (P<0.05). Cox regression model showed RDW, APACHE Ⅱ and qSOF were prognostic factors for sepsis (P<0.05). Kaplan Meier curve analysis indicated that the prognosis of patients with different qSOFA and RDW differed from each other statistically (P<0.05). Logistic regression model displayed that combined qSOFA and RDW was a new index in the prognosis prediction of the elderly septic patients (-5.728+0.505×qSOFA+0.339×RDW), and ROC curve analysis indicated that the best cutoff value of this index was -0.6144, with the sensitivity and specificity of 60.87% and 79.49%, respectively, which were better than single index. Conclusion qSOFA and RDW are the influencing factors of the prognosis of the elderly septic patients, and qSOFA combined with RDW has better sensitivity and specificity in prognostic evaluation of the elderly septic patients.