Objective To explore the predictive value of augmented renal clearance (ARC) on the therapeutic efficacy of cefoperazone sodium/sulbactam sodium injections in elderly patients in intensive care unit (ICU), thus providing theoretical reference for clinical diagnosis and treatment. Methods A total of 528 elderly patients admitted to the Intensive Care Department of Linyi People's Hospital from January 2020 to December 2021 were selected and allocated to ARC group (n=106) and non-ARC group (n=422) based on the occurrence of ARC. Baseline characteristics, deep steady-state trough concentration of cefoperazone sodium/sulbactam sodium (measured the efficacy of cefoperazone sodium/sulbactam sodium on half an hour before the medication) were collected and compared. Univariable and multivariable logistic regression analyses were performed to identify risk factors for the therapeutic efficacy of cefoperazone sodium/sulbactam sodium on elderly patients in ICU, and the predictive value on the efficacy was assessed by plotting the receiver operating characteristic curve. Results The incidence of ARC in this study was 20.1%. There were no significant differences in sex, body mass index (BMI), total protein, albumin, globulin, albumin/globulin ratio, alanine aminotransferase, total bilirubin, and uric acid between the two groups (P>0.05). Compared with those of the non-ARC group, patients in the ARC group were significantly younger with significantly lower blood urea nitrogen and creatinine, and higher creatinine clearance rate (CCr) and glomerular filtration rate (GFR)(P<0.05). There were significant differences in the deep steady-state trough concentration of cefoperazone sodium/sulbactam sodium and clinical outcomes between groups (P<0.05). Compared with those of the non-ARC group, patients in the ARC group had a significantly longer length of stay and higher mortality (P<0.05). Multivariate logistic regression analysis showed that ARC, age, blood urea nitrogen, creatinine, CCr, and GFR were all independent risk factors for the efficacy of cefoperazone sodium/sulbactam sodium injections on elderly patients in ICU (P<0.05). The receiver characteristic curve showed that the area under the curve of ARC predicting the efficacy of cefoperazone sodium/sulbactam sodium injections in elderly ICU patients was 0.828, with a sensitivity of 89.69% and a specificity of 78.28%.Conclusion ARC has a good predictive value for the efficacy of cefoperazone sodium/sulbactam sodium injections on elderly patients in ICU.