There still are people surviving without the patch. (Aren't there Wyv?)
There are some cheats the patch prevents you from doing, so don't install the patch if you want to use them.
If you almost quit playing the game because you hate waiting for the NPCs to finish talking: don't install the patch: you're forced to wait for the shopkeepers to finish talking with it.
If you look at the list of fixed things and think "this sounds useful": by all means go ahead.
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