Publications by authors named "Krzysztof Simon"

125 Publications

The chest radiographic scoring system in initial diagnosis of COVID-19: Is a radiologist needed?

Adv Clin Exp Med 2021 Jul 30. Epub 2021 Jul 30.

Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.

Background: Lung imaging, next to a polymerase chain reaction (PCR) test, is a key diagnostic tool in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The degree of abnormalities correlates with clinical outcome. Imaging of the lungs using chest radiography (CXR) at the peak of a pandemic is considered a basic diagnostic tool at the triage stage. The CXR images are less characteristic than computed tomography (CT) and should be interpreted with a combination of clinical findings.

Objectives: Comparison of the usefulness of 2 CXR severity scores to evaluate the presence/severity of inflammation in the course of COVID-19 and the possibility of a non-radiologist to interpret the image independently.

Material And Methods: Retrospective analysis of the medical records of 152 consecutive patients (aged 19-96, 73 men), infected with SARS-CoV-2, confirmed using real-time PCR (RT-PCR). Five-point and twelve-point CXR severity scoring systems were used (independently by a radiologist and a referring physician) to assess the severity of inflammation.

Results: In 77 of 152 cases, the CXR revealed features of inflammation. Bilateral abnormalities were found in 48/77 (62.3%) cases. Statistically, the lower lobes were involved more often than the upper ones (p < 0.001) and the left lobe more often than the right one (p < 0.001). The intensity of the abnormalities using both scales correlated with the persistence of symptoms (p = 0.0133 and p = 0.0403). A positive and statistically significant correlation was found between both scales and dyspnea, decreased oxygen saturation, elevated C-reactive protein (CRP), ferritin, D-dimer, lactate dehydrogenase, and alanine aminotransferase activity. The interobserver agreement analysis did not show a statistically significant difference in the CXR severity score using the five-point (B = 0.8345, kappa = 0.82; p = 0.1480) or the twelve-point scale (B = 0.8219, kappa = 0.77; p = 0.0502).

Conclusions: The CXR severity score is a useful tool to assess the inflammation in the initial diagnosis of coronavirus disease 2019 (COVID-19). Quantifying lung abnormalities accurately may be performed by a referring physician. Both CXR severity scales correlate well with clinical parameters.
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http://dx.doi.org/10.17219/acem/139717DOI Listing
July 2021

Lenvatinib versus sorafenib for first-line treatment of unresectable hepatocellular carcinoma: patient-reported outcomes from a randomised, open-label, non-inferiority, phase 3 trial.

Lancet Gastroenterol Hepatol 2021 Aug 2;6(8):649-658. Epub 2021 Jun 2.

FSBSI N N Blokhin Russian Cancer Research Center, Moscow, Russia.

Background: Hepatocellular carcinoma is the third-leading cause of cancer-related death worldwide. Preservation of health-related quality of life (HRQOL) during treatment is an important therapeutic goal. The aim of this study was to evaluate the effect of treatment with lenvatinib versus sorafenib on HRQOL.

Methods: REFLECT was a previously published multicentre, randomised, open-label, non-inferiority phase 3 study comparing the efficacy and safety of lenvatinib versus sorafenib as a first-line systemic treatment for unresectable hepatocellular carcinoma. Eligible patients were aged 18 years or older with unresectable hepatocellular carcinoma and one or more measurable target lesion per modified Response Evaluation Criteria in Solid Tumors criteria, Barcelona Clinic Liver Cancer stage B or C categorisation, Child-Pugh class A, Eastern Cooperative Oncology Group (ECOG) performance status of 1 or lower, and adequate organ function. Patients were randomly assigned (1:1) via an interactive voice-web response system; stratification factors for treatment allocation included region; macroscopic portal vein invasion, extrahepatic spread, or both; ECOG performance status; and bodyweight. Patient-reported outcomes (PROs), collected at baseline, on day 1 of each subsequent cycle, and at the end of treatment, were evaluated in post-hoc analyses of secondary and exploratory endpoints in the analysis population, which was the subpopulation of patients with a PRO assessment at baseline. A linear mixed-effects model evaluated change from baseline in PROs, including European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and hepatocellular carcinoma-specific QLQ-HCC18 scales (both secondary endpoints of the REFLECT trial). Time-to-definitive-deterioration analyses were done based on established thresholds for minimum differences for worsening in PROs. Responder analyses explored associations between HRQOL and clinical response. This study is registered with ClinicalTrials.gov, NCT01761266.

Findings: Of 954 eligible patients randomly assigned to lenvatinib (n=478) or sorafenib (n=476) between March 14, 2013, and July 30, 2015, 931 patients (n=468 for lenvatinib; n=463 for sorafenib) were included in this analysis. Baseline PRO scores reflected impaired HRQOL and functioning and considerable symptom burden relative to full HRQOL. Differences in overall mean change from baseline estimates in most PRO scales generally favoured the lenvatinib over the sorafenib group, although the differences were not nominally statistically or clinically significant. Patients treated with lenvatinib experienced nominally statistically significant delays in definitive, meaningful deterioration on the QLQ-C30 fatigue (hazard ratio [HR] 0·83, 95% CI 0·69-0·99), pain (0·80, 0·66-0·96), and diarrhoea (0·52, 0·42-0·65) domains versus patients treated with sorafenib. Significant differences in time to definitive deterioration were not observed for other QLQ-C30 domains, and there was no difference in time to definitive deterioration on the global health status/QOL score (0·89, 0·73-1·09). For most PRO scales, differences in overall mean change from baseline estimates favoured responders versus non-responders. Across all scales, HRs for time to definitive deterioration were in favour of responders; median time to definitive deterioration for responders exceeded those for non-responders by a range of 4·8 to 14·6 months.

Interpretation: HRQOL for patients undergoing treatment for unresectable hepatocellular carcinoma is an important therapeutic consideration. The evidence of HRQOL benefits in clinically relevant domains support the use of lenvatinib compared with sorafenib to delay functional deterioration in advanced hepatocellular carcinoma.

Funding: Eisai and Merck Sharp & Dohme.
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http://dx.doi.org/10.1016/S2468-1253(21)00110-2DOI Listing
August 2021

Immunosuppression as a Hallmark of Critical COVID-19: Prospective Study.

Cells 2021 05 23;10(6). Epub 2021 May 23.

Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland.

The dysregulation of both the innate and adaptive responses to SARS-CoV-2 have an impact on the course of COVID-19, and play a role in the clinical outcome of the disease. Here, we performed a comprehensive analysis of peripheral blood lymphocyte subpopulations in 82 patients with COVID-19, including 31 patients with a critical course of the disease. In COVID-19 patients who required hospitalization we analyzed T cell subsets, including Treg cells, as well as TCRα/β and γ/δ, NK cells, and B cells, during the first two weeks after admission to hospital due to the SARS-CoV-2 infection, with marked reductions in leukocytes subpopulations, especially in critically ill COVID-19 patients. We showed decreased levels of Th, Ts cells, Treg cells (both naïve and induced), TCRα/β and γ/δ cells, as well as CD16+CD56+NK cells in ICU compared to non-ICU COVID-19 patients. We observed impaired function of T and NK cells in critically ill COVID-19 patients with extremely low levels of secreted cytokines. We found that the IL-2/INFγ ratio was the strongest indicator of a critical course of COVID-19, and was associated with fatal outcomes. Our findings showed markedly impaired innate and adaptive responses in critically ill COVID-19 patients, and suggest that the immunosuppressive state in the case of a critical course of SARS-CoV-2 infection might reflect subsequent clinical deterioration and predict a fatal outcome.
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http://dx.doi.org/10.3390/cells10061293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224622PMC
May 2021

Factors influencing the failure of interferon-free therapy for chronic hepatitis C: Data from the Polish EpiTer-2 cohort study.

World J Gastroenterol 2021 May;27(18):2177-2192

Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok 15-540, Poland.

Background: The introduction of direct-acting antiviral drugs into clinical practice has revolutionized the treatment of chronic hepatitis C, making it highly effective and safe for patients. However, few researchers have analyzed the factors causing therapy failure in some patients.

Aim: To analyze factors influencing the failure of direct antiviral drugs in the large, multicenter EpiTer-2 cohort in a real-world setting.

Methods: The study cohort consisted of patients with chronic hepatitis C treated at 22 Polish centers from 2016-2020. Data collected from the online EpiTer-2 database included the following: hepatitis C virus (HCV) genotype, stage of fibrosis, hematology and liver function parameters, Child-Turcotte-Pugh and Model for End-stage Liver Disease scores, prior antiviral therapy, concomitant diseases, and drugs used in relation to hepatitis B virus (HBV) and/or human immunodeficiency virus (HIV) coinfections. Adverse events observed during the treatment and follow-up period were reported. Both standard and machine learning methods were used for statistical analysis.

Results: During analysis, 12614 patients with chronic hepatitis C were registered, of which 11938 (mean age: 52 years) had available sustained virologic response (SVR) data [11629 (97%) achieved SVR and 309 (3%) did not]. Most patients (78.1%) were infected with HCV genotype 1b. Liver cirrhosis was diagnosed in 2974 patients, while advanced fibrosis (F3) was diagnosed in 1717 patients. We included patients with features of hepatic failure at baseline [ascites in 142 (1.2%) and encephalopathy in 68 (0.6%) patients]. The most important host factors negatively influencing treatment efficacy were liver cirrhosis, clinical and laboratory features of liver failure, history of hepatocellular carcinoma, and higher body mass index. Among viral factors, genotype 3 and viral load also exerted an influence on treatment efficacy. Classical statistical analysis revealed that treatment ineffectiveness seemed to be influenced by the male sex, which was not confirmed by the multivariate analysis using the machine learning algorithm (random forest). Coinfection with HBV (including patients with on-treatment reactivation of HBV infection) or HIV, extrahepatic manifestations, and renal failure did not significantly affect the treatment efficacy.

Conclusion: In patients with advanced liver disease, individualized therapy (testing for resistance-associated variants and response-guided treatment) should be considered to maximize the chance of achieving SVR.
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http://dx.doi.org/10.3748/wjg.v27.i18.2177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117732PMC
May 2021

Value of quantitative analysis in lung computed tomography in patients severely ill with COVID-19.

PLoS One 2021 20;16(5):e0251946. Epub 2021 May 20.

Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.

Introduction: Quantitative computed tomography (QCT) is used to objectively assess the degree of parenchymal impairment in COVID-19 pneumonia.

Materials And Methods: Retrospective study on 61 COVID-19 patients (severe and non-severe; 33 men, age 63+/-15 years) who underwent a CT scan due to tachypnea, dyspnoea or desaturation. QCT was performed using VCAR software. Patients' clinical data was collected, including laboratory results and oxygenation support. The optimal cut-off point for CT parameters for predicting death and respiratory support was performed by maximizing the Youden Index in a receiver operating characteristic (ROC) curve analysis.

Results: The analysis revealed significantly greater progression of changes: ground-glass opacities (GGO) (31,42% v 13,89%, p<0.001), consolidation (11,85% v 3,32%, p<0.001) in patients with severe disease compared to non-severe disease. Five lobes were involved in all patients with severe disease. In non-severe patients, a positive correlation was found between severity of GGO, consolidation and emphysema and sex, tachypnea, chest x-ray (CXR) score on admission and laboratory parameters: CRP, D-dimer, ALT, lymphocyte count and lymphocyte/neutrophil ratio. In the group of severe patients, a correlation was found between sex, creatinine level and death. ROC analysis on death prediction was used to establish the cut-off point for GGO at 24.3% (AUC 0.8878, 95% CI 0.7889-0.9866; sensitivity 91.7%, specificity 75.5%), 5.6% for consolidation (AUC 0.7466, 95% CI 0.6009-0.8923; sensitivity 83.3%, specificity 59.2%), and 37.8% for total (GGO+consolidation) (AUC 0.8622, 95% CI 0.7525-0.972; sensitivity 75%, specificity 83.7%). The cut-off point for predicting respiratory support was established for GGO at 18.7% (AUC 0.7611, 95% CI 0.6268-0.8954; sensitivity 87.5%, specificity 64.4%), consolidation at 3.88% (AUC 0.7438, 95% CI 0.6146-0.8729; sensitivity 100%, specificity 46.7%), and total at 23.5% (AUC 0.7931, 95% CI 0.673-0.9131; sensitivity 93.8%, specificity 57.8%).

Conclusion: QCT is a good diagnostic tool which facilitates decision-making regarding intensification of oxygen support and transfer to an intensive care unit in patients severely ill with COVID-19 pneumonia. QCT can make an independent and simple screening tool to assess the risk of death, regardless of clinical symptoms. Usefulness of QCT to predict the risk of death is higher than to assess the indications for respiratory support.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251946PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136668PMC
June 2021

Real-world direct-acting antiviral treatment in kidney transplant and hemodialysis patients: the EpiTer-2 multicenter observational study.

Ann Gastroenterol 2021 5;34(3):438-446. Epub 2021 Feb 5.

Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok (Tadeusz W. Łapiński, Robert Flisiak).

Background: Patients who undergo hemodialysis (HD) or kidney transplantation (KTx) previously had limited possibilities for treatment of hepatitis C virus (HCV) infection. Direct-acting antivirals (DAA) give these patients a chance of virus eradication and safe transplantation. The aim of this study was to evaluate the effectiveness and safety of DAA in KTx and HD patients in real-world settings.

Methods: Sustained virologic response (SVR) and treatment safety were analyzed in KTx and HD patients from the EpiTer-2 database, which included HCV-infected subjects treated with DAA between 2015 and 2019. Additionally, for KTx patients, changes in creatinine concentration, estimated glomerular filtration rate (eGFR), proteinuria within a year after treatment, and changes in the need for calcineurin inhibitors were assessed.

Results: Among 10,152 patients from the EpiTer-2 database 148 were selected, 85 after KTx and 63 undergoing HD. The most common genotype, 1b HCV, was found in 73% and 86% of patients, respectively. Cirrhosis was noted in 10% and 19%, respectively. The most common DAA regimen after KTx was sofosbuvir/ledipasvir (54%), whereas in HD patients it was ombitasvir/paritaprevir/ritonavir +/- dasabuvir (56%). All patients with available follow-up results achieved SVR. No deaths, kidney loss or acute rejection episodes were noted. The most common adverse effects in both groups were anemia and weakness. One year after treatment, creatinine concentration, eGFR and proteinuria remained stable in the majority of patients.

Conclusion: DAA treatment of HCV infection demonstrated high effectiveness and safety in hemodialyzed patients and patients who had undergone KTx in this real-world study.
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http://dx.doi.org/10.20524/aog.2021.0595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079881PMC
February 2021

Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6.

J Clin Med 2021 Apr 9;10(8). Epub 2021 Apr 9.

Department of Infectious Diseases, Jan Kochanowski University, 25-369 Kielce, Poland.

Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.08-0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ≤ 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ≤ 90%.
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http://dx.doi.org/10.3390/jcm10081583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070099PMC
April 2021

Early Administration of Convalescent Plasma Improves Survival in Patients with Hematological Malignancies and COVID-19.

Viruses 2021 03 8;13(3). Epub 2021 Mar 8.

Department and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367 Wroclaw, Poland.

The use of convalescent plasma in the treatment of COVID-19 may lead to a milder course of infection and has been associated with improved outcomes. Determining optimal treatments in high risk populations is crucial, as is the case in those with hematological malignancies. We analyzed a cohort of 23 patients with hematological malignancies and COVID-19 who had received plasma 48-72 h after the diagnosis of infection and compared it with a historical group of 22 patients who received other therapy. Overall survival in those who received convalescent plasma was significantly higher than in the historical group ( = 0.03460). The plasma-treated group also showed a significantly milder course of infection ( = 0.03807), characterized by less severe symptoms and faster recovery ( = 0.00001). In conclusion, we have demonstrated that convalescent plasma is an effective treatment and its early administration leads to clinical improvement, increased viral clearance and longer overall survival in patients with hematological malignancies and COVID-19. To our knowledge, this is the first report to analyze the efficacy of convalescent plasma in a cohort of patients with hematological malignancies.
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http://dx.doi.org/10.3390/v13030436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001057PMC
March 2021

The Strategies to Support the COVID-19 Vaccination with Evidence-Based Communication and Tackling Misinformation.

Vaccines (Basel) 2021 Feb 1;9(2). Epub 2021 Feb 1.

Collegium Medicum, Warsaw Faculty of Medicine, Cardinal Stefan Wyszyński University, 01-938 Warsaw, Poland.

COVID-19 vaccinations are about to begin in various countries or are already ongoing. This is an unprecedented operation that is also met with a loud response from anti-vaccine communities-currently using all available channels to manipulate public opinion. At the same time, the strategy to educate on vaccinations, explain their mechanism of action, and build trust in science is subdued in different world parts. Such actions should go much beyond campaigns promoting the COVID-19 vaccines solely on the information provided by the health institutions and national authorities. In this paper, actions provided by independent expert groups needed to counteract the anti-vaccine propaganda and provide scientific-based information to the general public are offered. These actions encompass organizing groups continuously communicating science on COVID-19 vaccines to the general public; tracking and tackling emerging and circulating fake news; and equipping celebrities and politicians with scientific information to ensure the quality of messages they communicate, as well as public letters, and statements of support for vaccination by healthcare workers, recognized scientists, VIPs, and scientific societies; and no tolerance to false and manipulated claims on vaccination spread via traditional and social media as well as by health professionals, scientists, and academics. These activities should be promptly implemented worldwide, regardless of the current status and availability of the COVID-19 vaccine in a particular region. If we are about to control the pandemic for the sake of public benefit, it is high time to collectively speak out as academic and medical societies with support from decision-makers. Otherwise, the battle will be lost to those who stand against scientific evidence while offering no feasible solution to the problem.
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http://dx.doi.org/10.3390/vaccines9020109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912910PMC
February 2021

Lymphocyte subsets in haematological patients with COVID-19: Multicentre prospective study.

Transl Oncol 2021 Jan 11;14(1):100943. Epub 2020 Nov 11.

Department and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367 Wroclaw, Poland.

The role of immune dysregulation in the course and prognosis of COVID-19 is not clearly established. In particular, immune status in specific populations such as haematological patients, who have an impaired immunological system, has not been described so far. Here, we performed a comprehensive analysis of peripheral blood lymphocyte subsets in 27 SARS-CoV-2-infected patients, including 16 patients with haematological malignancies. We identified T cell subpopulations, B cells, NK cells and TCR α/ß and ɣ/ƍ-expressing T cells during COVID-19 infection, with significant changes observed in immune profiles during the course of disease, especially in haematological patients. We observed an increase in activated T lymphocytes (CD3+HLA-DR+ and CD3+CD8+HLA-DR+) in the early stages of SARS-CoV-2 infection with a concomitant decrease in the CD4/CD8 ratio in haematological patients compared to non-haematological patients affected by COVID-19. We also found a decrease in ɣ/ƍ T cells in both studied groups of patients, with lower numbers of CD25+ T cells and CD16+CD56+ NK cells in haematological patients compared to non-haematological patients with COVID-19. Our findings demonstrate, for the first time, impaired adaptive immunity in patients with haematological malignancies infected with COVID-19, resulting in impaired cellular immune responses to SARS-CoV-2. This warrants further investigation of this disease group in COVID-19 patient cohorts.
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http://dx.doi.org/10.1016/j.tranon.2020.100943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657028PMC
January 2021

Is an 8-week regimen of glecaprevir/pibrentasvir sufficient for all hepatitis C virus infected patients in the real-world experience?

J Gastroenterol Hepatol 2021 Jul 23;36(7):1944-1952. Epub 2020 Nov 23.

Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland.

Background And Aims: The revolution of the antiviral treatment of hepatitis C virus (HCV) infection resulting in higher effectiveness came with the introduction of direct-acting antivirals with pangenotypic regimens as a final touch. Among them, the combination of glecaprevir (GLE) and pibrentasvir (PIB) provides the opportunity for shortening therapy to 8 weeks in the majority of patients. Because of still insufficient evaluation of this regimen in the real-world experience, our study aimed to assess the efficacy and safety of 8-week GLE/PIB in chronic hepatitis C patients depending on liver fibrosis and genotype (GT).

Methods: The analysis included patients who received GLE/PIB for 8 weeks selected from the EpiTer-2 database, large retrospective national real-world study evaluating antiviral treatment in 12 584 individuals in 22 Polish hepatology centers.

Results: A total of 1034 patients with female predominance (52%) were enrolled in the analysis. The majority of them were treatment naïve (94%), presented liver fibrosis (F) of F0-F3 (92%), with the most common GT1b, followed by GT3. The overall sustained virologic response after exclusion of nonvirologic failures was achieved in 95.8% and 98%, respectively (P = 0.19). In multivariate logistic regression HCV GT-3 (beta = 0.07, P = 0.02) and HIV infection (beta = -0.14, P < 0.001) were independent predictors of nonresponse.

Conclusions: We demonstrated high effectiveness of 8-week GLE/PIB treatment in a non-GT3 population irrespective of liver fibrosis stage. Comparable efficacy was achieved in non-cirrhotic patients regardless of the genotype, including GT3 HCV.
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http://dx.doi.org/10.1111/jgh.15337DOI Listing
July 2021

Serum concentrations of selected adipokines in virus-related liver cirrhosis and hepatocellular carcinoma.

Clin Exp Hepatol 2020 Sep 30;6(3):235-242. Epub 2020 Sep 30.

Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wroclaw, Poland.

Aim Of The Study: Hepatotropic viruses cause metabolic disturbances such as insulin resistance and hepatosteatosis. Moreover, metabolic factors, such as insulin resistance, obesity, and type 2 diabetes mellitus, increase the risk for hepatocellular carcinoma (HCC) in patients with virus-related liver cirrhosis. Cytokines secreted by the adipose tissue (adipokines) may be implicated in these metabolic disturbances, but there is little evidence regarding the role of adipokines in virus-related cirrhosis and HCC. Thus, we studied whether serum concentrations of selected adipokines were altered in patients with virus-related liver cirrhosis, including patients with HCC.

Material And Methods: We included 43 patients with liver cirrhosis due to chronic hepatitis B or chronic hepatitis C. Of these patients, 36 had HCC and 7 did not have any malignant lesions. In addition to routine clinical and laboratory variables, we analyzed serum concentrations of betatrophin, insulin, vaspin, visfatin, and irisin.

Results: Compared with healthy controls, patients with HCC had significantly increased vaspin concentrations and significantly reduced irisin concentrations. Compared with controls, patients with virus-related cirrhosis, with or without HCC, had significantly increased concentrations of insulin and betatrophin. The serum visfatin concentration was non-significantly higher in patients with virus-related cirrhosis than in controls. None of the studied adipokines was a significant predictor of HCC. Serum concentrations of the studied adipokines were not related to cirrhosis severity or HCC stage.

Conclusions: Metabolic parameters, including serum adipokine concentrations, are altered in patients with virus-related liver cirrhosis. Adipokines might be related to the HCC risk in these patients.
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http://dx.doi.org/10.5114/ceh.2020.99517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592085PMC
September 2020

Recommendations of the Polish Group of Experts for HCV for the treatment of hepatitis C in 2020.

Clin Exp Hepatol 2020 Sep 1;6(3):163-169. Epub 2020 Sep 1.

Department of Infectious Diseases and Hepatology, Medical University of Białystok, 14 Żurawia St., 15-540 Bialystok, Poland.

The recommendations set out the principles of diagnosis and treatment of hepatitis C virus (HCV) infections according to the most recent knowledge. The main goal of therapy for HCV infection is to eliminate the virus from the body, which consequently leads to arrest of progress or regression of changes in the liver. Current version of the recommendations prioritise pangenotypic regimens and provide guidelines in special populations of patients, such as children, cirrhotics, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfected, those with renal failure, hepatic decompensation and non-responders to previous therapies.
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http://dx.doi.org/10.5114/ceh.2020.98606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592092PMC
September 2020

Nosocomial outbreak of SARS-CoV-2 infection in a haematological unit - High mortality rate in infected patients with haematologic malignancies.

J Clin Virol 2020 Sep 1;130:104574. Epub 2020 Aug 1.

Department and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367, Poland. Electronic address:

Background: Here we report nosocomial outbreak of COVID-19 among patients in a haematological unit. To our knowledge this is the first report from Central Europe comparing morbidity and mortality in infected and non-infected patients after exposure to SARS-CoV-2.

Methods: The outbreak involved 39 individuals: 19 patients and 20 health care workers. The SARS-CoV-2 test by nasopharyngeal swabs was performed by real-time RT-PCR. Exposed patients were divided into two groups: quarantine patients with and without COVID-19. All patients were prospectively examined at the following time points: 0, 7 days, 14 days, 21 days and 28 days after confirmation or exclusion of SARS-CoV-2.

Results: Infection was confirmed in a total of 5/20 health care workers and 10/19 patients. Among the patients positive for SARS-CoV-2 infection, the mortality rate was 36.8 %. The probability of death in patients infected with SARS-CoV-2 increased 8-fold (p = 0.03). Bacterial, fungal, and viral co-infection significantly decreased survival in these patients (p < 0.05). Additionally, the probability of death was much higher in patients older than 40 years of age (p = 0.032).

Conclusion: This study showed significantly higher mortality rate in COVID-19 patients with haematologic diseases compared to the non-infected patient group. Haematologic patients with COVID-19 have 50 % less chance of survival.
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http://dx.doi.org/10.1016/j.jcv.2020.104574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395815PMC
September 2020

Searching for the optimal population for hepatitis C virus screening in Poland.

Clin Exp Hepatol 2020 Jun 30;6(2):74-76. Epub 2020 Apr 30.

Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland.

Aim Of The Study: The purpose of the study was to select the optimal target population for a possible national hepatitis C virus (HCV) screening program in Poland, based on the most recent available data.

Material And Methods: The analysis included 723,654 participants from different populations screened for anti-HCV. Testing was performed in the whole blood using rapid anti-HCV kits. Presence of HCV RNA was additionally demonstrated in some anti-HCV positive patients with the real-time polymerase chain reaction method.

Results: Altogether 3,548 anti-HCV positive individuals were identified, so the prevalence rate in the whole studied population was 0.5%. The highest percentage (1.2%) was shown by diagnostic laboratories, which offered rapid testing for patients visiting their offices during the HCV awareness campaign. Relatively high anti-HCV prevalence of 0.6-0.7% was noted in hospitals and in private medical centers, as well as during music concerts. Surprisingly, the lowest prevalence (0.2%) was observed in general practitioners' offices. Among 502 anti-HCV positive individuals tested additionally for HCV RNA, viremic presence was demonstrated in 40%.

Conclusions: Anti-HCV testing in Poland should be carried out using rapid anti-HCV kits at the patients' admission to the hospitals and should also be offered to patients during their visits for any purpose in diagnostic laboratories or private medical centers.
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http://dx.doi.org/10.5114/ceh.2020.94969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380468PMC
June 2020

Chloroquine and hydroxychloroquine for the prevention and therapy of coronavirus disease 2019: new hopes and old cardiovascular concerns.

Kardiol Pol 2020 08 14;78(7-8):811-817. Epub 2020 Jul 14.

Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland; Center for Heart Diseases, University Hospital, Wrocław, Poland

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http://dx.doi.org/10.33963/KP.15511DOI Listing
August 2020

Usefulness of a portable chest radiograph in the initial diagnosis of coronavirus disease 2019.

Pol Arch Intern Med 2020 10 15;130(10):906-909. Epub 2020 Jul 15.

Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wrocław, Poland

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http://dx.doi.org/10.20452/pamw.15512DOI Listing
October 2020

Low risk of HBV reactivation in a large European cohort of HCV/HBV coinfected patients treated with DAA.

Expert Rev Anti Infect Ther 2020 10 27;18(10):1045-1054. Epub 2020 Jun 27.

Department of Infectious Diseases and Hepatology, Medical University of Białystok , Białystok, Poland.

Objectives: The aim of the study was to analyze the prevalence and clinical characteristics of HCV/HBV coinfection and to evaluate the rate of HBV-reactivation during anti-HCV therapy in a large real-world study.

Methods: Analyzed population consisted of 10,152 chronic hepatitis C patients treated with DAA between 2015 and 2019 in a nationwide study. Prior to the DAA all subjects had HBsAg and 60% anti-HBc testing.

Results: 111 of 10,152 patients (1.1%) had detectable HBsAg and 1239 of 6139 (20.2%) anti-HBcAb. The prevalence of occult hepatitis B was 0.48%. HCV/HBV patients were younger with a higher proportion of males, HIV-coinfected, and advanced fibrosis. They were less often diagnosed with diabetes but more often with chronic kidney disease. In HBsAg(+) subjects with baseline HBV-DNA available 6/102 (5.9%) HBV-reactivations during or after DAA therapy were observed, and in two (1.9%) significant hepatic flares were noted. In HBsAg(-)/anti-HBc(+) group 2 (0.16%) reactivations were observed only in patients undergoing immunosuppressive therapy.

Discussion: Data from a large European cohort suggest a relatively low risk of HBV-reactivation during DAA-therapy for HCV infection in HBsAg(+) patients. In HBsAg(-)/anti-HBc(+) HBV-reactivation seems to be limited to subjects with immunodeficiency. Importantly, previous exposure to HBV and occult hepatitis B is present in a significant proportion of HCV-infected.
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http://dx.doi.org/10.1080/14787210.2020.1782189DOI Listing
October 2020

Rapid progression of inflammatory pulmonary infiltrates in severe acute respiratory syndrome coronavirus 2 infection in a young man.

Pol Arch Intern Med 2020 04 8;130(4):326-327. Epub 2020 Apr 8.

1st Department of Infectious Diseases, J. Gromkowski Specialist Regional Hospital, Wrocław, Poland; Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wrocław, Poland

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http://dx.doi.org/10.20452/pamw.15290DOI Listing
April 2020

Severe course of coronavirus disease 2019 in a middle-aged man without risk factors.

Pol Arch Intern Med 2020 04 3;130(4):330-331. Epub 2020 Apr 3.

Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wrocław, Poland; First Department of Infectious Disease, J. Gromkowski Specialist Regional Hospital, Wrocław, Poland

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http://dx.doi.org/10.20452/pamw.15277DOI Listing
April 2020

Gastrointestinal symptoms as the first, atypical indication of severe acute respiratory syndrome coronavirus 2 infection.

Pol Arch Intern Med 2020 04 3;130(4):338-339. Epub 2020 Apr 3.

Department of Infectious Diseases, Wroclaw Medical University, Wrocław, Poland; 1st Department of Infectious Diseases, J. Gromkowski Specialist Regional Hospital, Wrocław, Poland

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http://dx.doi.org/10.20452/pamw.15278DOI Listing
April 2020

Differences in the courses of meningococcal and pneumococcal cerebrospinal meningitis.

Neurol Neurochir Pol 2020 20;54(1):39-46. Epub 2020 Jan 20.

Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu.

Neisseria meningitidis and Streptococcus pneumoniae are the most common pathogens causing cerebrospinal meningitis (CSM) in adults. The mortality rate and the number of complications remain high. In our study, retrospective evaluations were conducted on data concerning 98 adult patients with bacterial cerebrospinal meningitis caused by Neisseria meningitidis (n = 42) and Streptococcus pneumoniae (n = 56), hospitalised at the Regional Specialistic Hospital in Wroclaw (Poland) within the period 1998-2018. Compared to the group infected with S. pneumoniae, patients infected with N. meningitidis were younger and were less often affected by an additional disease burden; they presented more frequently with haemorrhagic rashes. Compared to the S. pneumoniae group, in patients with meningococcal CSM, cytosis in cerebrospinal fluid measuring < 1,000 cells/ mL was less frequent; intravascular coagulation syndrome appeared more frequently; the hospitalisation time was shorter and the rate of mortality was lower. Meningococcal meningitis occurs more frequently among young people with no history of disease. It is characterised by the rapid development of symptoms, which results in earlier diagnosis and more favourable prognosis compared to cases of S. pneumoniae. Irrespective of the pathogen, advanced age and a level of cytosis in cerebrospinal fluid of < 1,000 cells /μl indicate an unfavourable prognosis.
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http://dx.doi.org/10.5603/PJNNS.a2020.0002DOI Listing
March 2020

Serum visfatin and vaspin levels in hepatocellular carcinoma (HCC).

PLoS One 2020 14;15(1):e0227459. Epub 2020 Jan 14.

Department of Infectious Diseases and Hepatology, Wrocław Medical University, Wroclaw, Poland.

Hepatocellular carcinoma (HCC) is the most common liver cancer, accountable for 90% cases. Visfatin and vaspin are adipocytokines with various suggested functions and proven significant correlations between BMI and percentage of body fat. The aim was to assess visfatin and vaspin serum levels in HCC patients and controls, compare their levels in patients with different cancer etiology and grade assessed according to the Barcelona-Clinic Liver Cancer (BCLC) staging system. The additional aim was to analyze relationship between analyzed adipokines and metabolic abnormalities and liver disfunction severity. The study was performed on 69 cirrhotic patients (54 males/15 females) with HCC, aged 59.0 ± 12.1 years, and with BMI 29.0 ± 4.5 kg/m2 compared to 20 healthy volunteers. Serum visfatin and vaspin concentrations were significantly increased in HCC patients compared to controls (p = 0.01 and p = 0.02, respectively). Serum vaspin was significantly higher in HCC patients with viral compared to those with non-viral etiology (p = 0.02), with more evident increase in chronic hepatitis C patients (CHC). Serum visfatin levels were significantly higher in patients with higher insulin resistance (p = 0.04) and with platelets count > 100 000/mm3 (p<0.001). Patients with BMI >30 kg/m2 had markedly up-regulated vaspin levels (p = 0.04). There was no difference in vaspin and visfatin serum levels with respect to liver dysfunction and BCLC classification. In conclusion, our study revealed serum vaspin and visfatin to be significantly increased in HCC patients independently of cancer etiology compared to controls. Additionally, serum vaspin was elevated in viral disease, especially in CHC. Vaspin up-regulation can be a compensatory mechanism against IR in HCC patients. Serum visfatin and vaspin, although up-regulated, seem not to be associated with cancer grade and cirrhosis severity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227459PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959555PMC
April 2020

Comparative effectiveness of 8 versus 12 weeks of Ombitasvir/Paritaprevir/ritonavir and Dasabuvir in treatment-naïve patients infected with HCV genotype 1b with non-advanced hepatic fibrosis.

Adv Med Sci 2020 Mar 13;65(1):12-17. Epub 2019 Dec 13.

Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Białystok, Poland.

Purpose: Since 2017 treatment-naïve patients infected with genotype 1b of hepatitis C virus and minimal or moderate fibrosis can be treated with Ombitasvir/Paritaprevir/ritonavir + Dasabuvir (OPrD) for 8 weeks according to updated Summary of Product Characteristics. The aim of our study was to assess the comparative efficacy of 8 and 12-weeks therapy with OPrD in large cohort of patients eligible for 8 weeks regimen treated in real-world setting.

Materials And Methods: We analysed data of 3067 HCV genotype 1b infected patients treated with OPrD between 2015 and 2017. Final analysis included patients with none, minimal or moderate fibrosis (F0-F2).

Results: A total of 771 patients were enrolled in the study, including 197 (26%) treated for 8-weeks and 574 patients fulfilling criteria for 8-weeks but assigned to 12-weeks regimen. Majority of patients had no or minimal fibrosis (F0-F1). Longer treatment duration was more often administered in patients with moderate fibrosis, comorbidities, concomitant medications. SVR was achieved in 186 (94%) patients treated for 8 weeks and 558 (97%) for 12 weeks (p = 0.07). After exclusion of lost to follow-up patients, sustained virological response (SVR) rate reached 95% and 99%, respectively (p = 0.01). We were not able to identify factors associated with non-response.

Conclusions: This real-word experience study confirmed similar, high effectiveness of 8 and 12-weeks regimens of OPrD in genotype 1b HCV infected patients with non-advanced fibrosis. Despite of reduced SVR rate after 8-weeks regimen, there is no need to extend therapy to 12-weeks in vast majority of such patients and no need to add ribavirin.
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http://dx.doi.org/10.1016/j.advms.2019.09.002DOI Listing
March 2020
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