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The Multidimensional Prognostic Index (MPI) has shown utility in predicting short-term outcomes, but its role over extended follow-up requires further investigation. The objective of this study is to evaluate the ability of an MPI-based model to predict 3.5-year mortality in older adults hospitalized for COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center cohort study with prospective follow-up included 183 patients aged\u2009\u2265\u200965\u00a0years hospitalized with confirmed SARS-CoV-2 infection. MPI was calculated at admission and dichotomized into low (classes 1\u20132) and high (class 3). Multivariable Cox regression was used to estimate the hazard of mortality over a 3.5-year follow-up. Discriminative performance was assessed using time-dependent ROC analysis, with AUC values compared between the multivariable model and MPI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During follow-up, 81\/183 patients (44.3%) died. Kaplan\u2013Meier curves showed lower survival in high-MPI patients (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0043). A Cox model with a time-varying effect for sex (sex\u2009\u00d7\u2009log(time)) confirmed that high MPI was associated with higher mortality (HR\u2009=\u20091.59, 95% CI 1.00\u20132.52), age was also associated (HR per year\u2009=\u20091.04, 95% CI 1.00\u20131.07), while vaccination was not. The female-to-male hazard ratio changed over time (HR at 180\/365\/730\/1250\u00a0days: 0.90\/1.31\/1.87\/2.48). AUCs for the full model at 180\/365\/730\/1250\u00a0days were 0.704\/0.654\/0.680\/0.659, derived from the sex-stratified Cox linear predictor, and exceeded the MPI-only model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The MPI demonstrated moderate prognostic ability for long-term mortality among older adults after COVID-19. Adding demographic and clinical variables modestly improved prediction, supporting the role of multidimensional assessment in geriatric prognosis, while highlighting the need for cautious interpretation over extended follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11739-025-04178-w","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T16:41:20Z","timestamp":1762533680000},"page":"459-467","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex and the Multidimensional Prognostic Index in 3.5-year post-COVID-19 mortality among older adults: evidence of a time-varying effect"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5064-1672","authenticated-orcid":false,"given":"Chiara","family":"Ceolin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Liberati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margherita","family":"Vergadoro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Simonato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Cazzavillan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario Virgilio","family":"Papa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia Salerno","family":"Trapella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"Di Marzio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno Micael","family":"Zanforlini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Curreri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Bertocco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Gasparini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Devita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Coin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Spiezia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Sergi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"De Rui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"issue":"5","key":"4178_CR1","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1111\/imj.15698","volume":"52","author":"A Subramaniam","year":"2022","unstructured":"Subramaniam A et al (2022) Frailty and mortality associations in patients with COVID-19: a systematic review and meta-analysis. 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