The expression level of programmed death ligand 1 (PD-L1) is the only approved biomarker for predicting response to immunotherapy, yet its efficacy is not always consistent. Lactate dehydrogenase (LDH) has been associated with tumor aggressiveness and poorer prognosis across various cancer types and may serve as a useful biomarker for monitoring treatment response. The objective of this study is to analyze the relationship between LDH levels prior to the start of treatment with immune checkpoint inhibitors (ICIs) and clinical outcomes in patients with non-small cell lung cancer (NSCLC). A retrospective study was conducted including patients diagnosed with NSCLC who were treated with at least 3 cycles of immunotherapy. Data on demographics, clinical and pathological characteristics, treatment received, pretreatment LDH levels, and clinical outcomes such as treatment response and overall survival (OS) were analyzed. A total of 181 patients diagnosed with NSCLC were included. Elevated pretreatment LDH levels (>244 U/L) were associated with significantly reduced OS. The median survival was 548 days in patients with LDH ≤ 244 U/L, compared to 332 days in those with LDH > 244 U/L (P = .037). Among men, OS was greater in the LDH ≤ 244 U/L group (623 days) versus 332 days in the LDH > 244 U/L group (P = 0.043). In patients with metastatic disease, OS was higher in those with LDH ≤ 244 U/L (474 days) compared to 249 days in those with LDH > 244 U/L (P = .023). In patients receiving both immunotherapy and chemotherapy, OS was greater in those with LDH ≤ 244 U/L (623 days) compared to 281 days in the LDH > 244 U/L group (P = .042). High levels of LDH prior to the start of treatment with ICIs are associated with lower treatment efficacy and a worse prognosis of the disease, especially in male, metastatic patients with a PD-L1 expression level <1%.

Polypharmacy is a common problem in older adults with hip fractures and may negatively affect postoperative outcomes. The aim of this study was to evaluate the association between polypharmacy, including severe polypharmacy, and clinical outcomes in older adults admitted to hospital with hip fracture. A real-life observational study was conducted at a tertiary care hospital in Spain, including patients aged ≥ 70 years who underwent hip fracture surgery between January 1, 2017, and December 31, 2018. Data were extracted from electronic medical records, including demographic details, comorbidities, and medication use. Polypharmacy was defined as the use of five or more medications, and severe polypharmacy as the use of ten or more medications. Mortality rates were analyzed at 30 days, 6 months, 1 year, 2 years, and 5 years post-surgery using Kaplan–Meier survival curves and Cox regression analysis. Among 644 patients included (mean age 84.5 years, 70.5% women), 63.8% had polypharmacy and 19.1% had severe polypharmacy. Compared with patients without polypharmacy, those with polypharmacy, regardless of severity, showed higher mortality at 30 days (8.4% and 10.3% vs 3.9%), 6 months (21.3% and 21.4% vs 10.8%), 1 year (26.6% and 33.3% vs 11.6%), 2 years (38.8% and 46.0% vs 14.2%), and 5 years (68.5% and 76.2% vs 26.3%) (all p ≤ 0.05). Crude hazard ratios for 5-year mortality were 3.65 (95% CI 2.73–4.88) for patients taking 5–9 drugs and 4.51 (95% CI 3.26–6.24) for those taking ≥ 10 drugs; after full adjustment, these remained 3.12 and 3.46, respectively. Patients with polypharmacy also had more red blood cell transfusions, major complications, and worse functional recovery. Polypharmacy was associated with worse postoperative morbidity, poorer functional recovery, and higher mortality in older adults with hip fracture. These findings suggest that medication burden may serve as a marker of clinical vulnerability rather than an isolated causal factor. Prospective interventional studies are needed to determine whether medication optimization improves outcomes.

Objetivo: el nivel de expresión del ligando 1 de muerte programada (PD-L1) es el único biomarcador aprobado para predecir la respuesta a la inmunoterapia, pero su eficacia no siempre es consistente. La lactato deshidrogenasa (LDH) se ha asociado con la agresividad tumoral y un peor pronóstico en varios tipos de cáncer, y podría ser un biomarcador útil para monitorear la respuesta al tratamiento. El objetivo de este estudio es analizar la relación entre los niveles de LDH previos al inicio del tratamiento con inhibidores del punto de control inmunitario (ICI) y los resultados clínicos en pacientes con cáncer de pulmón no microcítico (CPNM). Método: se realizó un estudio retrospectivo de pacientes diagnosticados de CPNM tratados con al menos 3 ciclos de inmunoterapia. Se analizaron datos demográficos, características clínicas y patológicas, tratamiento recibido, niveles de LDH antes del tratamiento y resultados clínicos como respuesta al tratamiento y la supervivencia global (SG). Resultados: un total de 181 pacientes diagnosticados de CPNM fueron incluidos. Los niveles elevados de LDH (superiores a 244 U/l) antes del tratamiento con inmunoterapia se asociaron con una SG significativamente menor. La mediana de supervivencia fue de 548 días en pacientes con LDH menor que 244 U/l, comparado con 332 días en aquellos con LDH mayores que 244 U/l (p = 0,037). En hombres, la supervivencia global fue mayor en el grupo con LDH menor que 244 U/l (623 días) frente a 332 días en aquellos con LDH mayores que 244 U/l (p = 0,043). En pacientes con enfermedad metastásica, la supervivencia global fue mayor en aquellos con LDH menores que 244 U/l (474 días) comparado con 249 días en aquellos con LDH superiores a 244 U/l (p = 0,023). En pacientes tratados con inmunoterapia y quimioterapia, la supervivencia global fue mayor en aquellos con LDH inferiores a 244 U/l (623 días) frente a 281 días en el grupo con LDH mayor que 244 U/l (p = 0,042). Conclusiones: niveles elevados de LDH previo al inicio del tratamiento con ICI se asocian con una menor eficacia al tratamiento y un peor pronóstico de la enfermedad, especialmente en pacientes varones, metastásicos y con un nivel de expresión de PD-L1 menor al 1%. Objective: The expression level of programmed death ligand 1 (PD-L1) is the only approved biomarker for predicting response to immunotherapy, yet its efficacy is not always consistent. Lactate dehydrogenase (LDH) has been associated with tumor aggressiveness and poorer prognosis across various cancer types and may serve as a useful biomarker for monitoring treatment response. The objective of this study is to analyze the relationship between LDH levels prior to the start of treatment with immune checkpoint inhibitors (ICIs) and clinical outcomes in patients with non-small cell lung cancer (NSCLC). Method: A retrospective study was conducted including patients diagnosed with NSCLC who were treated with at least three cycles of immunotherapy. Data on demographics, clinical and pathological characteristics, treatment received, pre-treatment LDH levels, and clinical outcomes such as treatment response and overall survival (OS) were analyzed. Results: A total of 181 patients diagnosed with NSCLC were included. Elevated pre-treatment LDH levels (more than 244 U/l) were associated with significantly reduced OS. The median survival was 548 days in patients with LDH less than 244 U/l, compared to 332 days in those with LDH more than 244 U/l (p = 0.037). Among men, OS was greater in the LDH less than 244 U/l group (623 days) versus 332 days in the LDH more than 244 U/l group (p = 0.043). In patients with metastatic disease, OS was higher in those with LDH less than 244 U/l (474 days) compared to 249 days in those with LDH more than 244 U/l (p = 0.023). In patients receiving both immunotherapy and chemotherapy, OS was greater in those with LDH less than 244 U/l (623 days) compared to 281 days in the LDH more than 244 U/l group (p = 0.042). Conclusions: High levels of LDH prior to the start of treatment with ICIs are associated with lower treatment efficacy and a worse prognosis of the disease, especially in male, metastatic patients with a PD-L1 expression level less than 1%.

Background and Objectives: Malnutrition is highly prevalent among older adults with hip fracture and is associated with poorer surgical outcomes, yet its prognostic relevance is often under-recognized in routine orthopaedic practice. The Controlling Nutritional Status (CONUT) score is an objective laboratory-based screening tool; however, evidence regarding its value for predicting long-term mortality after hip fracture remains limited. This study aimed to evaluate whether nutritional status assessed by the CONUT score independently predicts mortality in older patients with hip fracture. Materials and Methods: This retrospective observational cohort study included consecutive patients aged ≥70 years admitted for hip fracture to a tertiary hospital between 2014 and 2021. Nutritional status was assessed at admission using the CONUT score and categorized as no, mild, moderate, or severe nutritional risk. Demographic characteristics, comorbidity burden, perioperative variables, postoperative morbidity, and mortality up to five years were recorded. Survival was evaluated using Kaplan–Meier methods, and independent predictors of mortality were identified using multivariable Cox proportional hazards models adjusted for clinically relevant confounders. Results: A total of 2798 patients were included (mean age [SD] 84.3 [6.3] years; 26.4% male), of whom 79.2% presented some degree of nutritional risk at admission. Mortality increased overall with worsening nutritional status (p < 0.001). After comprehensive multivariable adjustment, higher CONUT scores remained independently associated with mortality, with each one-point increase associated with an approximately 22% higher risk of long-term death. Poorer nutritional status was also associated with higher postoperative complication rates, greater transfusion requirements, and longer hospital stay. Conclusions: Nutritional status assessed using the CONUT score is an independent predictor of short-, mid-, and long-term mortality in older patients undergoing surgery for hip fracture. Incorporation of objective nutritional screening into orthogeriatric pathways may improve perioperative risk stratification and support targeted multidisciplinary management.

Purpose: Polypharmacy is a common problem in surgical patients with hip fractures. Their influence on the mortality is what we pretend to study, aiming to inform management strategies and reduce mortality risks. Methods: A retrospective study was conducted at Hospital de la Ribera, Alzira, targeting patients aged ≥70 who underwent hip fracture surgery in 2017 and 2018. Data were extracted from electronic medical records, including demographic details, comorbidities, and medication use. Polypharmacy was defined as the use of five or more medications. Mortality rates were analyzed at 30 days, 6 months, 1 year, 2 years, and 5 years post-surgery using Kaplan-Meier survival curves and Cox regression analysis. Results: Among 644 patients included, (mean age 84.5 years, 70.5%women), polypharmacy was present in 63.8%, and severe polypharmacy (≥10 medications) in 19.1% of patients. Polypharmacy significantly increased mortality at all time intervals: 30 days (10.6% severe polypharmacy vs 3.0% no polypharmacy, p=0.042), 6 months (22.7% vs 9.6%, p=0.003), 1 year (39.4% vs 11.9%, p<0.001), 2 years (51.5% vs 14.8%, p<0.001), and 5 years (76.2% vs 26.3%, p<0.001).It was also associated with higher rates of major complications and red cell transfusions. Hazard ratios for 5-year mortality were significantly elevated for patients on hypotensives, benzodiazepines, antidiabetics, opioids, neuroleptics, and anti-dementia drugs. Conclusion: Polypharmacy significantly impacts postoperative mortality and morbidity in elderly hip fracture patients. Effective management, including medication review and deprescribing strategies, is crucial to improving outcomes. Comprehensive geriatric assessments and interdisciplinary approaches are recommended to optimize treatment and reduce the adverse effects of polypharmacy.