Internal and emergency medicine · 2025
Sex and the Multidimensional Prognostic Index in 3.5-year post-COVID-19 mortality among older adults: evidence of a time-varying effect.
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Ceolin Chiara, Liberati Veronica, Vergadoro Margherita, Simonato Cristina, Cazzavillan Sara, Papa Mario Virgilio, Trapella Giulia Salerno, Di Marzio Benedetta, Zanforlini Bruno Micael, Curreri Chiara, Bertocco Anna, Gasparini Giulia, Devita Maria, Coin Alessandra, Spiezia Luca, Sergi Giuseppe, De Rui Marina
Аннотация
PURPOSE: The long-term prognostic impact of frailty in older adults recovering from COVID-19 remains underexplored. 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.
METHODS: This single-center cohort study with prospective follow-up included 183 patients aged ≥ 65 years hospitalized with confirmed SARS-CoV-2 infection. MPI was calculated at admission and dichotomized into low (classes 1-2) 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.
RESULTS: During follow-up, 81/183 patients (44.3%) died. Kaplan-Meier curves showed lower survival in high-MPI patients (log-rank p = 0.0043). A Cox model with a time-varying effect for sex (sex × log(time)) confirmed that high MPI was associated with higher mortality (HR = 1.59, 95% CI 1.00-2.52), age was also associated (HR per year = 1.04, 95% CI 1.00-1.07), while vaccination was not. The female-to-male hazard ratio changed over time (HR at 180/365/730/1250 days: 0.90/1.31/1.87/2.48). AUCs for the full model at 180/365/730/1250 days were 0.704/0.654/0.680/0.659, derived from the sex-stratified Cox linear predictor, and exceeded the MPI-only model.
CONCLUSIONS: 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.
METHODS: This single-center cohort study with prospective follow-up included 183 patients aged ≥ 65 years hospitalized with confirmed SARS-CoV-2 infection. MPI was calculated at admission and dichotomized into low (classes 1-2) 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.
RESULTS: During follow-up, 81/183 patients (44.3%) died. Kaplan-Meier curves showed lower survival in high-MPI patients (log-rank p = 0.0043). A Cox model with a time-varying effect for sex (sex × log(time)) confirmed that high MPI was associated with higher mortality (HR = 1.59, 95% CI 1.00-2.52), age was also associated (HR per year = 1.04, 95% CI 1.00-1.07), while vaccination was not. The female-to-male hazard ratio changed over time (HR at 180/365/730/1250 days: 0.90/1.31/1.87/2.48). AUCs for the full model at 180/365/730/1250 days were 0.704/0.654/0.680/0.659, derived from the sex-stratified Cox linear predictor, and exceeded the MPI-only model.
CONCLUSIONS: 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.