Objective To investigate the predictive value of vasoactive inotropic score (VIS) for the clinical outcome of septic shock in the elderly. Methods Clinical data of 93 elderly patients with septic shock admitted in our hospital from January 2018 to December 2019 were collected and retrospectively analyzed. Based on the vital signs and laboratory results for diagnosing sepsis and septic shock, Acute Physiology and Chronic Health EvaluationⅡ score (APACHE Ⅱ) and sequential organ failure assessment score (SOFA) were calculated during sepsis, and the highest VIS in the first 48 h diagnosed with septic shock was also calculated. According to clinical outcome in 28 d after septic shock, the patients were divided into the death group and the survival group. Age, gender, smoking and drinking history, biochemical indicators, APACHE Ⅱ score, SOFA score, VIS, use of vasoactive drugs, and involved organ dysfunction were compared among different groups. Univariate and multivariate logistic regression analyses were used to analyze the risk factors of death in elderly patients with septic shock within 28 d. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of SOFA score, APACHE Ⅱ score and VIS for death in 28 d. SPSS statistics 24.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test, nonparametric test, Fisher exact probability test or Chi-square test depending on data type. Results Within 28 d of follow-up, 55 patients (59.14%) died and assigned into the death group, and 38 (40.86%) survived and served as the survival group. The death group had significantly higher APACHE Ⅱ score, SOFA score, VIS, proportion of patients using vasoactive drugs and IL-6 level than the survival group (P<0.05). Multivariate logistic regression analysis showed APACHE Ⅱ score (OR=1.228,95%CI 1.051-1.436), SOFA score (OR=1.505,95%CI 1.084-2.091), VIS (as continuous variable, OR=1.027,95%CI 1.002-1.054), and VIS ≥17.06 (as categorical variable, OR=7.523,95%CI 1.445-39.154) were independent risk factors of 28 d death in elderly patients with septic shock (P<0.05). The AUC value of APACHE Ⅱ score, SOFA score and VIS in predicting 28 d death was 0.911 (95%CI 0.852-0.969), 0.895 (95%CI 0.825-0.964) and 0.763 (95%CI 0.663-0.862) respectively in elderly patients with septic shock. The combined detection of multiple indicators had better accuracy in the prediction for the short-term outcome. The AUC value of VIS combined with APACHE Ⅱ score was 0.926, with a sensitivity of 0.836 and a specificity of 0.947, and the value of VIS combined with SOFA score was 0.911, with a sensitivity of 0.945 and a specificity of 0.763. The cut-off point of VIS was 17.06 points, with a sensitivity of 0.691 and a specificity of 0.789. Conclusion The highest VIS in the first 48 h diagnosed with septic shock is related to the clinical outcome in the elderly, and is an independent risk factor to predict 28 d death in them. VIS can be used as an indicator to evaluate the prognosis of elderly patients with septic shock.