OBJECTIVE: The objective of this study was to systematically identify and evaluate scoring systems that predict the prognosis of patients with sepsis-induced myocardial injury (SIMI). METHODS: Data were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Logistic and Cox regression analyses were conducted to identify risk factors associated with 28-day mortality in patients with sepsis-induced myocardial injury (SIMI). The prognostic performance of the scoring systems was comprehensively assessed using receiver operating characteristic (ROC) curves, Kaplan-Meier survival and decision curve analysis (DCA). RESULTS: Logistic regression analysis showed that Acute Physiology Score III (APSIII) (Odds Ratio [OR] =1.011, 95% Confidence Interval [CI] 1.002-1.018, P=0.005), Sequential Organ Failure Assessment (SOFA) (OR =1.097, 95% CI 1.045-1.144, P<0.001), and Charlson Comorbidity Index (CHARLSON) (OR=1.095, 95% CI 1.048-1.145, P=0.036) were independent risk factors for 28-day mortality in SIMI patients. Cox regression analysis confirmed that SOFA (HR=1.082, 95% CI 1.054- 1.111, P<0.001), APSIII (HR=1.010, 95% CI 1.005-1.015, P<0.001), and CHARLSON (HR=1.044, 95% CI 1.012-1.077, P=0.007) were independent risk factors. ROC curve analysis showed that SOFA (AUC=0.685, 95% CI 0.663-0.707) and APSIII (AUC=0.683, 95% CI 0.662-0.705) had significantly higher AUC values compared to other scoring systems. DCA results showed that APSIII and SOFA had better net benefit than other scoring systems. CONCLUSIONS: The SOFA and APSIII scores effectively identified high-risk patients with SIMI, providing evidence-based support for early clinical intervention.