Search Results (250)

Background/Objectives: Type 2 respiratory failure (T2RF) is associated with significant morbidity and mortality, partly driven by cardiopulmonary interactions and right ventricular (RV) dysfunction. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio has emerged as a non-invasive marker of RV–pulmonary arterial (RV–PA) coupling; however, its prognostic value in T2RF remains insufficiently explored. This study aimed to evaluate the association between TAPSE/sPAP and short-term clinical outcomes in hospitalized T2RF patients. Methods: In this retrospective cohort study, 182 adult patients hospitalized with T2RF between January 2024 and December 2025 were included. Patients were followed from hospital admission until discharge or death, and survival status was additionally evaluated up to 60 days after admission using hospital electronic medical records and follow-up databases for Kaplan–Meier survival analysis. Complete follow-up data were available for all included patients. Demographic, clinical, laboratory, and transthoracic echocardiographic data were analyzed. Patients were stratified into low and high TAPSE/sPAP groups. The primary outcome was in-hospital mortality; secondary outcomes included 60-day all-cause mortality, non-invasive ventilation (NIV) failure, intensive care unit (ICU) admission, and length of hospital stay. Statistical analyses included receiver operating characteristic (ROC) curves, multivariable logistic regression, calibration assessment, and decision curve analysis. Results: Patients with a low TAPSE/sPAP ratio had significantly higher in-hospital mortality (38.6% vs. 12.8%, p < 0.001), higher rates of NIV failure and ICU admission, and longer hospital stays. TAPSE/sPAP demonstrated the highest predictive performance for mortality (AUC: 0.82, 95% CI: 0.75–0.88), outperforming conventional echocardiographic parameters. In multivariable analysis, TAPSE/sPAP remained an independent predictor of mortality (OR: 1.48 per 0.1 decrease, p < 0.001). The model showed good calibration (Hosmer–Lemeshow p = 0.62), and decision curve analysis confirmed its clinical utility with a higher net benefit across a wide range of threshold probabilities. Conclusions: The TAPSE/sPAP ratio was independently associated with in-hospital mortality and adverse clinical outcomes in patients with T2RF, reflecting impaired RV–PA coupling. As a readily obtainable non-invasive echocardiographic parameter, it demonstrated promising prognostic value for risk stratification in this population. However, given the retrospective single-center design of the study, these findings should be considered hypothesis-generating and require confirmation in prospective multicenter studies before routine clinical implementation can be recommended. Full article

Circulating myeloid cells are critical regulators of pancreatic ductal adenocarcinoma (PDAC) progression. However, their postoperative dynamics and clinical relevance remain poorly defined. In a prospective longitudinal study, blood was collected from PDAC patients prior to surgery and on postoperative day 7. Flow cytometry was used to characterize monocytes, including classical (CM), intermediate (IMM), and non-classical (NCM) subsets, along with regulatory and co-stimulatory molecules (CD71, CD40, CD141, CD80, CD86, PD-L1). Cytokine levels (IL-6, IL-10, TNF-α, IL-1β) were quantified by ELISA and correlated with clinical parameters and survival. Total monocytes and CM increased significantly at day 7, whereas IMM and NCM decreased. CD71, CD141, CD80, and CD86 expression were significantly altered across subsets, with the most pronounced reduction observed in CD86 expressing NCM. CD86 expressing NCM correlated inversely with systemic bilirubin but not CEA, lymphocytes, thrombocytes, or hospital stay. IL-6 and IL-10 increased postoperatively; IL-10 showed a tendency toward inverse correlation with CD86⁺ NCM. Low CD86 expression on NCM at day 7 was associated with reduced survival and higher relapse probability. CD86 expression on NCMs is profoundly reduced after PDAC surgery and serves as a prognostic biomarker linked to inflammation, bilirubin metabolism, survival, and recurrence. Postoperative monocyte profiling may improve risk stratification and inform early clinical decision-making. Full article

The aquaculture of Octopus vulgaris faces high larval mortality, mainly due to nutritional limitations and susceptibility to pathogens, particularly Vibrio spp. As vaccination is not feasible in cephalopods, host-associated probiotics represent a promising and sustainable alternative to improve survival and reduce infections. This study evaluated bacteria from the Roseobacter clade as probiotic candidates during octopus embryonic and paralarval stages. Characterization of egg-associated microbiota revealed the absence of cultivable bacteria within eggs and a significantly lower bacterial load on egg surfaces under maternal care, highlighting the regulatory role of female cleaning behavior. No bacteria with antagonism against Vibrio lentus, a common pathogen to octopus, were isolated from egg surfaces. Therefore, selected Roseobacter clade strains were screened in vitro against relevant aquaculture pathogens. Phaeobacter strains showed strong inhibitory activity against Vibrio spp., including V. lentus, while Ruegeria strains exhibited higher specificity against Tenacibaculum maritimum. Based on these results, Phaeobacter sp. 4UAC3 was selected for in vivo assays. This strain successfully colonized eggs, water, and paralarvae; however, its application reduced hatching success in eggs by 33%, likely due to surface-associated accumulation of the bacteria linked to the administration method. In contrast, probiotic treatment significantly improved survival at the paralarval stage. Although high variability was observed, probably due to stressful rearing conditions, more than 50% was observed in treated vs. 0% in non-treated cases at day 6. Overall, Phaeobacter sp. 4UAC3 emerges as a promising probiotic candidate to improve O. vulgaris paralarvae survival, potentially contributing to solving this bottleneck in a sustainable way. Full article

Urban festivals attract substantial numbers of tourists, which consequently imposes significant strain on host cities through spatial overcrowding, uneven pressure on infrastructure, and diminished quality of the visitor experience. Destination management organizations (DMOs) require effective tools to redistribute tourist flows; however, the influence of social media on tourists’ actual destination choices remains insufficiently understood. We ask whether social media discussion intensity (“buzz”) causally influences tourists’ destination choices and whether the effect grows stronger during festivals when information asymmetry is at its peak. Combining 95,692 taxi GPS trajectories with 5995 geotagged Twitter records from the 2019 Songkran Festival in Bangkok, we constructed an exponentially weighted moving average (EWMA) buzz variable with a temporal lag that establishes causal ordering. A conditional logit model shows that district-level buzz significantly raises destination choice probability and that the effect is amplified during the festival. Causal identification rests on a triangulated strategy that combines temporal lag, placebo permutation, and Bartik shift-share instrumental variables. The festival-period IV-corrected estimate (${\widehat{\beta }}^{\mathrm{IV}}=+0.019$, $p<0.001$) is 51% larger than the within-period OLS estimate (${\widehat{\beta }}^{\mathrm{OLS}}=+0.012$, $p<0.001$), a gap consistent with classical measurement-error attenuation in sparse social-media data, and a panel 2SLS analysis at the district–day level isolates a causal visitation channel confirming that cascades reinforce spatial concentration at the tourist-flow level. The aggregate Gini coefficient of spatial concentration declines over the study window in a statistically significant monotonic trend. The positive district-level correlation between buzz and congestion does not survive district and date fixed effects, which indicates that it reflects underlying differences in attractiveness across districts rather than a direct within-district channel. These findings provide an empirical foundation for information-based visitor flow management by identifying the underlying behavioral mechanism rather than evaluating a designed intervention. Full article

Background: Providing optimal parenteral nutrition to extremely preterm babies in the first week after birth is challenging, and different strategies may be associated with both short- and long-term outcomes. Methods: In a secondary cohort analysis of the ProVIDe trial, a multicentre, randomised, controlled trial in extremely-low-birthweight babies of increased amino acid intake in the first five days after birth, we explored the associations between parenteral amino acid and lipid intakes and blood spot amino acid concentrations, clinical outcomes and neurodevelopment. The cohort comprised 382 babies born in six New Zealand hospitals of whom 342 survived to 28 days. Nutritional intake data in the first week and newborn metabolic screening data on days 1, 5, 14, and 28 were retrieved, and 294 children were assessed for neurodevelopmental outcome at 2 years’ corrected age. Results: Blood spot amino acid concentrations were positively associated with amino acid intake (p < 0.005). Higher amino acid intakes were associated with increased odds (OR), 95% confidence intervals (CIs) of bronchopulmonary dysplasia (tyrosine: OR 2.2, CI 1.2–3.9; proline: OR 2.3, CI 1.3–4.0), patent ductus arteriosus and probable sepsis. No significant associations were found for necrotising enterocolitis. Higher lipid intakes were associated with lower odds of intraventricular haemorrhage (0.33 [0.16, 0.66]), bronchopulmonary dysplasia (0.31 [0.13, 0.73]) and retinopathy of prematurity (0.29 [0.12, 0.72]). Unlike short-term outcomes, neurodevelopment did not differ according to blood spot or intake quartile for any amino acid in week 1. Conclusions: Parenteral nutritional intakes in the first week after birth are associated with short-term outcomes. Further research is needed to optimise the composition of amino acid solutions. Trial Registration: ACTRN12612001084875, (accessed on 10 October 2012). Full article

Background/Objectives: Contrast-associated acute kidney injury (CA-AKI) is a frequent complication after coronary angiography (CAG) that may adversely affect outcomes in patients with acute coronary syndrome (ACS). We aimed to estimate the incidence of CA-AKI and evaluate its association with 30-day all-cause mortality in adults with ACS undergoing CAG. Methods: We conducted a retrospective cohort study; CA-AKI was defined as an increase in serum creatinine ≥0.5 mg/dL or ≥25% from baseline within 72 h after contrast exposure, according to KDIGO criteria. The primary outcome was 30-day all-cause mortality. Survival analyses were performed using Kaplan–Meier curves and Cox proportional hazards models. Results: Including 374 consecutive adults with ACS who underwent diagnostic or therapeutic CAG at a tertiary referral center. The mean age was 68.8 ± 11.2 years, and 72.6% were male. CA-AKI occurred in 17.4% of patients, and 11.7% died within 30 days. In multivariable analysis, age (HR 1.04; 95% CI 1.00–1.07), CA-AKI (HR 2.81; 95% CI 1.48–5.33), stress hyperglycemia ≥180 mg/dL (HR 2.88; 95% CI 1.54–5.38), and delirium (HR 7.20; 95% CI 2.40–20.92) were independent predictors of mortality. Conclusions: age, CA-AKI, stress hyperglycemia, and delirium independently predict short-term mortality after CAG in ACS, supporting integrated risk-stratified peri-procedural management. These observations suggest that mortality in these patients may be related to an inflammatory process secondary to ischemia/reperfusion, which is probably induced by dysregulation of the central autonomic network and activation of the hypothalamic–pituitary–adrenal axis which is currently underdiagnosed. Full article

In 2024 and 2025, researchers investigated the breeding ecology of the Twite Linaria flavirostris in riparian shrubland habitats at an elevation of 3400 m in the northeastern Qinghai–Tibet Plateau. This species lays eggs from late June to mid-July, capitalizing on the region’s brief warm season. Nests are typically open-cup structures built in Hippophae spp. shrubs. The population predominantly exhibits monogamous mating, with a mean clutch size of 4.7 ± 0.49 (3~5). Incubation is performed solely by the female and lasts 11.52 ± 1.65 days. Both parents provision the nestlings, and the nestling period lasts 12.43 ± 2.39 days. Morphological measurements of nestling body mass and external organs all fit well to the Logistic growth curve equation. By fledging, tarsus length and bill length reach over 90% of adult values, conferring substantial terrestrial mobility. However, flight-related feathers, primaries and rectrices, remain markedly underdeveloped compared to adults, resulting in extremely poor flight capability; further post-fledging development is thus required. Based on reproductive outcomes from this single breeding season, a total of 121 eggs were laid, of which 81 successfully hatched, and ultimately 79 fledglings survived to leave the nest. The overall hatching success was 66.94%, fledging success (among hatchlings) was 97.53%, and overall offspring survival (from eggs to fledglings) was 65.29%. The apparent nesting success rate was 76.0%, based on a total of 50 nests monitored over two years. Daily nest survival rates were estimated using Mayfield’s method and program MARK, resulting in nest success probabilities of 0.587 and 0.219, respectively. Comparing populations across different geographic regions, the results indicate that Twites breeding in environments with higher levels of environmental stress produce smaller clutch sizes and larger eggs, and exhibit a prolonged nestling period. This life-history strategy likely represents an evolutionary adaptation to spatially variable environmental conditions. Full article

Although increasing numbers of young people are trying to quit e-cigarettes, personalized tools to support vaping cessation remain limited. We aimed to build a machine learning model to predict individual probability of short-term relapses and identify person-specific barriers to successful cessation. Data were taken from the “Stop Vaping Challenge” smartphone app. We included past 30-day e-cigarette users aged 15–35 years (n = 311) who completed 387 quit challenges. Feature selection minimized number of predictors while maximizing predictive ability. We built multiple GBM survival models with different sets of predictors to predict time to vaping relapse. The five-feature model yielded the best performance (C-index 0.751), thereby was selected as the final model. These five features were: self-confidence in quitting, intention to quit, average e-liquid used per week, time to first vape and mood trend during challenge. We stratified the challenges by the individual relapse risk by 7 days into low-, medium-, and high probability of quit success. This approach can inform tailored quit plans for vaping cessation. SHAP analysis demonstrated individual-level barriers to cessation, which can guide the development of personalized, predictor-centric, adaptive behavioral interventions. However, future research is needed to implement the model in real-world settings and evaluate its effectiveness and generalizability. Full article

Importance: Immune checkpoint inhibitors (ICIs) have expanded downstaging options for hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), enabling bridging to liver transplantation (LT). However, the immunologic consequences of pre-transplant checkpoint blockade, particularly the risk of allograft rejection mediated by persistent T-cell activation, remain insufficiently characterized, creating a critical knowledge gap at the intersection of immuno-oncology and transplant medicine. Objective: To synthesize current evidence on oncologic outcomes, rejection risk, washout intervals, donor-type considerations, and immunosuppression strategies in LT recipients with pre-transplant ICI exposure. Evidence Review: A PRISMA-ScR-guided review was conducted using MEDLINE, Embase, Cochrane Library, and Web of Science from January 2015 through December 2025. Studies reporting outcomes in adult LT recipients with documented pre-transplant ICI exposure for HCC or CCA were included. Methodological quality was descriptively assessed using the Newcastle-Ottawa Scale and JBI tools. Given study heterogeneity, findings were narratively synthesized. Findings: Thirty studies were included. In HCC, neoadjuvant ICI therapy achieved downstaging to Milan criteria in 75.6% of candidates in the largest multicenter cohort (n = 117), with complete pathologic response rates ranging from 23.8% to 40%. Rejection rates ranged from 16.3% to 20.2% in large series but increased to 56.3% with short washout intervals. Washout intervals exceeding 50 days were associated with rejection rates approaching non-ICI controls, while an individual patient meta-analysis of 91 patients estimated each additional week of washout was associated with approximately 8% reduction in rejection risk, suggesting that approximately 94 days may be required to achieve a rejection probability of 20% or less. Rejection occurred at a median of 7–10 days post-transplantation, earlier than typical acute cellular rejection. Three-year overall survival exceeded 85.3% in major cohorts. Donor type was not consistently associated with rejection after adjustment for washout duration. CCA data remain limited. Immune-related adverse events during ICI therapy were associated with increased post-transplant rejection risk. Conclusions: Pre-transplant ICI therapy may expand transplant eligibility in advanced hepatobiliary malignancies but carries time-dependent rejection risk. Current evidence supports a minimum washout interval of at least 50 days, with emerging data favoring 90–94 days when feasible. Prospective multicenter studies, biomarker-guided risk stratification, and standardized immunosuppression protocols are needed to refine patient selection and optimize timing. Full article

Reduced levels of vitamin D are associated with increased incidence and mortality of sepsis. Nonetheless, the effectiveness of vitamin D supplementation in improving sepsis patients’ outcomes continues to be debated. In this research, which was conducted as a retrospective cohort analysis, data obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV 3.0) were used. The focus of the study was on vitamin D3 administration to sepsis patients while in the ICU. The primary outcome measurement was 28-day ICU mortality, with secondary outcomes of mechanical ventilation duration, percentage of patients receiving mechanical ventilation, and ICU stay length. The Kaplan–Meier curve analysis, Cox regression analysis, and subgroup analyses were performed to explore the link between vitamin D3 supplementation and sepsis prognosis. A 1:1 propensity score matching (PSM) approach was used to strengthen the reliability of the results. Before matching, the cohort comprised 28,524 patients, which was reduced to 4,856 after PSM. The analysis revealed that vitamin D3 supplementation was associated with a lower 28-day ICU mortality rate (HR = 0.71, 95% CI: 0.64–0.78, p < 0.001). Kaplan–Meier curve analysis revealed significantly greater survival probabilities in the group receiving vitamin D3 than in the group not receiving vitamin D3 (p < 0.001). Subgroup analysis showed that total cumulative exposure to vitamin D3 was more strongly associated with 28-day ICU mortality (p < 0.001), whereas daily dose and dosing frequency showed no significant association. The results after PSM and subgroup analysis were consistent with those of the original cohort study, further confirming the robustness of the results. Overall, vitamin D3 supplementation is associated with lower 28-day ICU mortality and better outcomes in patients with sepsis. However, given the retrospective observational design, large-scale prospective randomized controlled trials are warranted to validate these observational associations and establish causal effects. Full article

Anomala corpulenta (Motschulsky, 1854) (Coleoptera: Scarabaeidae), an important agricultural and forestry pest, is a beetle widely distributed in many countries, inflicting damage on numerous crops. Given the limited selectivity of commonly used light trapping devices for insects and their potential adverse effects on the ecological environment, there is a pressing need for innovative light control methods. This study investigates the effects of continuous exposure to yellow light on the behavioral activities of A. corpulenta adults, which are nocturnal. The experimental setup comprised a light experimental group (exposed continuously to yellow light at wavelengths of 565–585 nm and intensities of 30–40 lx at night) and a control group (kept in a dark room). Observations were made on emergence, mating, feeding, and mortality. Results showed that continuous exposure to yellow light significantly alters the emergence rhythm of A. corpulenta, leading to delays and dispersions in peak emergence, with emergence occurring during the light period. The emergence rates varied significantly from the control group during specific periods, and the overall emergence rate was notably affected, with female insects exhibiting greater sensitivity. Furthermore, food consumption and the number of mating pairs were significantly lower compared to the control group. Continuous exposure to yellow light also influenced the longevity of A. corpulenta; in the mixed test group, female insects had a lifespan of 20 days, while males lived for 18 days. In the sexually isolated test group, both sexes died within 16 days, with the survival rates of the experimental group being lower than those of the control group on certain days. This study concludes that continuous exposure to yellow light significantly modifies the emergence rhythm of A. corpulenta, while reducing the emergence rate, total food intake, and the number of mating pairs. Notably, in the mixed-sex test group, the survival probability of females in the experimental group was significantly lower than that of the control group. These findings provide a theoretical foundation for the light control of A. corpulenta and contribute to the field of insect visual ecology. Full article

Spodoptera frugiperda (fall armyworm) is a polyphagous pest with widespread resistance to synthetic insecticides, while essential oils (EOs) and biological control agents, such as the parasitoid Trichogramma pretiosum, represent promising strategies in integrated pest management (IPM) programs. This study evaluated the toxicity of Eugenia uniflora EO, popularly known as pitanga EO, and nanoemulsion (NEO) to S. frugiperda and the selectivity of the NEO to T. pretiosum. The EO of E. uniflora was characterized by GC-MS/DIC and then diluted in water and Tween 80^® for bioassays to estimate the LC₅₀ against S. frugiperda in Potter’s tower. The NEOs were produced by high-shear dispersion using an Ultra-Turrax and characterized for thermal stability, particle size, polydispersity index (PDI), zeta potential (ζ), temporal stability, and morphology. The NEO was diluted to the LC₅₀ (36.05 mg/mL) in 1% Tween 80^® solution and tested for toxicity to S. frugiperda and to the parasitoid. The majority compounds in the EO from E. uniflora were curzerene (34.07%), selina-1,3,7(11)-trien-8-one (10.51%), germacrene B (9.51%) and germacrene D (5.03%). The NEO stored at 25 °C remains stable for up to 30 days after preparation. In addition, the NEO showed a particle size of 283.2 nm, a PDI of 0.289, and a zeta potential (ζ) of −23.2 mV. The E. uniflora EO and NEO at a concentration of 36.05 mg/mL were toxic to S. frugiperda (36% probability of survival). Furthermore, NEO was selective for T. pretiosum in its immature stages. The NEO proved to be stable, effective, and selective, indicating potential for IPM. However, validation under semi-field and field conditions is still necessary. Full article

Background/Objectives: To estimate (a) survival after SARS-CoV-2 infection by COVID-19 vaccination status, and (b) COVID-19 vaccine effectiveness in a middle-income country. Methods: In this retrospective cohort study, secondary analysis of data from the national surveillance and vaccination databases was conducted. The primary outcome was COVID-19 death classified based on the WHO criteria. Data were analysed by vaccination status, age, sex, geographic region, and wave period. Kaplan–Meier curves were plotted; log-rank followed by multiple comparison tests were used to compare survival probabilities. Cox proportional-hazards models with time-varying covariates estimated hazard ratios (HR). Vaccine effectiveness was computed as (1-HR) × 100. Results: A total of 55,299 COVID-19 cases were captured by the national surveillance system between 1 April and 31 December 2021. Of these, 45,774 (1581 vaccinated, 44,193 unvaccinated) were included in the analysis. After a follow-up of 327 days, there were 22 deaths (case fatality rate (CFR) 1.5%) among 1581 COVID-19 vaccinated cases and 1821 deaths (CFR 4.1%) among 44,193 unvaccinated cases. There was one COVID-19 death per 10,000 person days in vaccinated cases compared with 2.7 COVID-19 deaths per 10,000 person days in unvaccinated cases. After adjustment for age, sex, and geographic region, the effectiveness against COVID-19 death across all vaccine types (ChAdOx1 nCoV-19, BNT162b2, Ad26.COV2.S, or BBIBP-CorV) was 68% (95% CI: 51–79). Effectiveness was 75% (95% CI: 59–84) for ChAdOx1 nCoV-19. Vaccine effectiveness across all vaccine types was higher in younger cases, (82% (95% CI: 52–93), 18–64 years vs. 63% (95% CI: 41–77), ≥65 years), females (84% (95% CI: 63–93), females vs. 53% (95% CI: 24–71), males) and those vaccinated in the past 3 months (71% (95% CI: 47–85), past 0–3 months vs. 56% (95% CI: 23–75), 3–6 months). Conclusions: COVID-19 vaccines were effective in preventing COVID-19 death in a population with low vaccination coverage. Limitations of the analysis include the use of surveillance data (under-reporting of cases, missing data), exclusion of partially vaccinated cases, and insufficient data on important confounders (circulating variants and comorbidities). Full article

Dairy cow longevity is a key driver of farm profitability, animal welfare, and environmental sustainability. Despite genetic progress in milk production, the average herd life has declined in many high-yielding dairy systems, raising concerns about early culling. This study analyzed data from 2057 Holstein–Friesian cows in Hungary to characterize the distribution and timing of culling events and to identify major risk factors affecting productive lifespan. We studied age, parity, milk yield, and culling reason using descriptive statistics, Kruskal–Wallis tests, multinomial logistic regression, and Kaplan–Meier survival analysis. Udder health problems were found to be the most frequent cause of culling (22.8%), followed by metabolic disorders (18.2%), locomotive problems (17.3%), and reproductive disorders (17.1%). Economic reasons such as low milk production contributed to a smaller proportion of culling. Most cows were culled after the second or third lactation, with survival probability dropping sharply within the first 1500–2000 days of life. Cows reaching four or more lactations represented a small but economically and genetically valuable subset of the herd. Our results indicated that in Hungary culling decisions are largely determined by health problems, which represent a greater limitation to the productive potential of dairy cows than economic factors. This research recommends that breeding programs prioritize genetic selection for robustness and that herd management adopts preventive health and reproductive strategies to prolong cow longevity, ultimately enhancing the efficiency and sustainability of dairy production systems. Additionally, prevention of animal wastage to foster animal welfare could be suggested as an additional advantage. Full article

Background: Hip fractures in older adults are sentinel events linked to high mortality and functional decline. Few studies have quantified long-term survival probabilities, standardized mortality ratios (SMRs), and risks of new nursing home admission alongside patient-related predictors. Methods: We retrospectively analyzed 355 patients aged ≥ 60 years who underwent hip fracture surgery at a general hospital in Japan (2020–2024). Primary outcomes were mortality and new nursing home admission. Survival probabilities and remaining life expectancy were estimated, and SMRs were calculated using age- and sex-matched national data. Cox regression identified independent predictors. Results: Mean age was 84 years; 76% were female. Mortality probabilities at 1, 2, and 3 years were 23%, 41%, and 60%, respectively; SMRs consistently exceeded 9. Median remaining life expectancy was 260 days. New nursing home admissions occurred in 42%, with cumulative probabilities of 16%, 27%, and 35% at 1, 2, and 3 years, respectively, showing a rapid rise within 9 months. Independent predictors of mortality were delayed surgery, higher Charlson Comorbidity Index, and low Geriatric Nutritional Risk Index. Older age and failure to regain ambulatory ability at 3 months predicted institutionalization. Conclusions: Older adults with hip fractures face persistently high mortality and institutionalization risks, comparable to advanced malignancies or neurodegenerative diseases. Surgical timing, comorbidities, nutrition, and functional recovery critically influence prognosis and should guide perioperative care and discharge planning. Full article