Papers by Lubomir Skladany
Background: It is assumed that the prevalence of hepatitis D in HBsAg-positive individuals reache... more Background: It is assumed that the prevalence of hepatitis D in HBsAg-positive individuals reaches 4.5-13% in the world, and on average about 3% in Europe. Data from several European countries, including Slovakia, are missing or are from an older period. Methods: We analyzed all available data on hepatitis D from Slovakia, including reports from the Slovak Public Health Authority and the results of one prospective study, and three smaller surveys. The determination of anti-HDV IgG and IgM antibodies and/or HDV RNA was used to detect hepatitis D. Results: In the years 2005-2022, no confirmed case of acute or chronic HDV infection was reported in Slovakia. The presented survey includes a total of 343 patients, of which 126 were asymptomatic HBsAg carriers, 33 acute hepatitis B, and 184 chronic hepatitis B cases. In a recent prospective study of 206 HBsAg-positive patients who were completely serologically and virologically examined for hepatitis B and D, only 1 anti-HDV IgG positive a...
Gastroenterologie a hepatologie, Apr 26, 2023
Current Oncology
Hepatocellular carcinoma (HCC) has multiple molecular classes that are associated with distinct e... more Hepatocellular carcinoma (HCC) has multiple molecular classes that are associated with distinct etiologies and, besides particular molecular characteristics, that also differ in clinical aspects. We aim to characterize the clinical aspects of alcoholic liver disease-related HCC by a retrospective observational study that included all consequent patients diagnosed with MRI or histologically verified HCC in participating centers from 2010 to 2016. A total of 429 patients were included in the analysis, of which 412 patients (96%) had cirrhosis at the time of diagnosis. The most common etiologies were alcoholic liver disease (ALD) (48.3%), chronic hepatitis C (14.9%), NAFLD (12.6%), and chronic hepatitis B (10%). Patients with ALD-related HCC were more commonly males, more commonly had cirrhosis that was in more advanced stages, and had poorer performance status. Despite these results, no differences were observed in the overall (median 8.1 vs. 8.5 months) and progression-free survival ...
Scientific Reports
Liver cirrhosis is associated with a poor quality of life (QOL). The COVID-19 pandemic has led to... more Liver cirrhosis is associated with a poor quality of life (QOL). The COVID-19 pandemic has led to several restriction measures and psychosocial consequences whose impact on QOL has combined with that of cirrhosis in an unknown way. Therefore, we have used our cirrhosis registry to assess the quality of life before the pandemic (on the first admission to the tertiary liver unit) and during the most pronounced phase of the first lockdown. In this cross-sectional study conducted during the first lockdown in Slovakia (from April to May 2020), we have repeated the QOL measurement of QOL in cirrhotic patients previously enrolled in the RH7 registry. Patients who were alive (according to the national registry of deaths) were identified and contacted by phone with a structured and standardized interview led by trained professionals. The tool used for both QOL measurements (at enrolment in RH7 and during lockdown) was a standardized and validated EuroQOL-5D (EQ-5D) questionnaire. The study i...
Frontiers in Psychology, Oct 12, 2022
Background: Alcohol consumption is an important issue. Adverse childhood experiences (ACEs) can a... more Background: Alcohol consumption is an important issue. Adverse childhood experiences (ACEs) can affect alcohol consumption later in life. Therefore, the main objective of this study was to test the association between ACE and the alcohol consumption in college students. Materials and methods: A cross-sectional study on college students was conducted during December 2021 and January 2022, Through the school web system, students received a standard questionnaire on alcohol consumption (AUDIT) and ACEs. The study involved 4,044 participants from three universities in Slovakia. Result: Compared to men, the incidence of emotional abuse by a parent, physical abuse by a parent, and sexual abuse was significantly higher in women (p < 0.001). Furthermore, women reported greater emotional and physical neglect (p < 0.001). The incidence of a high or very high AUDIT score in college students with ACE-0, ACE-1, ACE-2, ACE-3, and ACE-4+ was 3.8, 4.7, 4.1, 6.4, and 9.3%, respectively. Conclusion: More adverse childhood experiences were associated with increased alcohol consumption in both male and female university students. Baseline drinking was higher in male students, but increased drinking in relation to an increase in ACEs was higher in female students. These results point to gender-specific driving forces and targets for intervention.
Gastroenterologie a hepatologie, 2020
Background: Certain trials have demonstrated that surveillance of hepatocellular carcinoma (HCC) ... more Background: Certain trials have demonstrated that surveillance of hepatocellular carcinoma (HCC) lowers mortality via earlier diagnosis and therapy. We aimed to analyse surveillance performance in order to define targets for improvement. Methods: We retrospectively analysed consecutive patients (pts) ELIGIBLE for surveillance between January 2001 and December 2010, with three questions: 1. How many have had surveillance RECOMMENDED and 2. PERFORMED, and by which method and 3. with what outcome. We divided the pts into three groups by diagnosis of cirrhosis or HBV infection (ELIGIBLE), written recommendation for surveillance (RECOMMENDED) and ≥ 2 US or alpha-fetoprotein (AFP) exams six months apart (PERFORMED). We recorded the demographics, liver disease characteristics, ultrasound (US), AFP, new lesions, their size and mortality. We excluded patients without data for analysis. Results: We identified 445 and excluded 52 of the ELIGIBLE pts. The remaining 393 pts formed the RECOMMEN...
Gastroenterología y Hepatología, 2021
Introduction: Anabolic agents are prohibited in professional sports, but their availability makes... more Introduction: Anabolic agents are prohibited in professional sports, but their availability makes its use widespread among amateur athletes. Our goal was to report all cases of anabolic-induced liver injury. Patients and methods: We included all inpatients with acute liver injury and previous anabolic use over the last 4 years. We recorded history, demographics, laboratory data and imaging, histology, HPVG (hepatic venous pressure gradient) and the outcome. Results: Fifteen men with a median age of 33.1 years were identified. Common symptoms were dyspepsia (47%), jaundice (100%) and dark urine (26.7%); anabolics were used for a median of 66.5 days (25th–75th percentile, 18.3–113.5), baseline bilirubin level was 19.4-times higher than the upper limit of the normal (13.9–27.1), 1 patient (6.7%) had INR > 1.7. The character of the injury was cytolytic in 3 patients (20%), and cholestatic and mixed in 6 patients (40%). Signifi cant alcohol consumption was reported in 2 cases and 4 (2...
Klinicka mikrobiologie a infekcni lekarstvi, 2016
AIM OF STUDY Spontaneous bacterial peritonitis (SBP) is the most frequent infectious complication... more AIM OF STUDY Spontaneous bacterial peritonitis (SBP) is the most frequent infectious complication of liver cirrhosis with serious consequences. Initially, SBP is always treated with empirical, not targeted, antibiotic therapy. Since a retrospective study performed in our department showed suboptimal effectiveness (only 40 %) of empirical antibiotic therapy in accordance with the EASL guidelines, a decision was made to change the protocol. The aims of this prospective study were to determine: (1) the incidence and characteristics of SBP in real clinical practice - in a liver unit of a tertiary hospital, (2) the effectiveness of new antibiotic therapy selected based on analysis of the spectrum of pathogens and their resistance to antibiotics as identified in a retrospective cohort study on SBP carried out in our department, (3) mortality, and to compare these findings with the literature data. MATERIAL AND METHODS A prospective cohort observational pragmatic study. SETTING Department ...
Journal of Hepatology, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Vnitřní lékařství, 2020
Introduction: T-cell mediated rejection (TCMR) is still one of the most common non-surgical compl... more Introduction: T-cell mediated rejection (TCMR) is still one of the most common non-surgical complications following liver transplantation (LTx). Aims: To determine the prevalence, risk factors and outcome of TCMR after LTx from deceased donors (DDLT) in a single center. Methods: Retrospective analysis; Study interval: May 2008-December 2017. Inclusion criteria: DDLT at this TC; exclusion criteria: patients treated with CyA or basiliximab. Recorded variables: demographics, MELD score, Child-Pugh, etiology, CIT (Cold Ischemia Time), BG (blood groups), tacrolimus (TAC) on 5 th day post LTx and at discharge, length of hospital stay (LOS), survival. TCMR was defined histologically, liver biopsy was performed only in patients having an increase in liver function tests or unexplained liver dysfunction. Results: 193 patients were included, median age was 53.6, 41.3 % were females, median MELD score 16.0; Child-Pugh score 10. TCMR was diagnosed in 21 patients (11.4 %). The comparison between groups (TCMR and no-TCMR) showed the following differences: age: 54.3 vs 42.3 years (p = 0.073); etiology of autoimmune hepatitis (AIH) 33.3 vs 6.7 %, (p = 0.001), PSC (Primary Sclerosing Cholangitis) 19.0 vs 6.7 %, (p = 0.13). We observed no significant differences among other etiologies, CIT and BG. Level of TAC on the 5 th day post LTx was 5.
International Journal of Public Health, 2020
Objectives The MOSAIC study gathered data on chronic hepatitis C virus (HCV) infection and its tr... more Objectives The MOSAIC study gathered data on chronic hepatitis C virus (HCV) infection and its treatment in various countries worldwide. Here we summarise patient and HCV characteristics in the Czech Republic and Slovakia. Methods MOSAIC was an observational study that included patients with chronic HCV infection untreated at the time of enrolment. Study collected and descriptively analysed patient demographics, disease stage and viral characteristics. Data were collected between February 2014 to October 2014.
Vnitřní lékařství, 2018
Súhrn Obezita dosahuje rozmery globálnej epidémie. Priamo prispieva k nárastu prevalencie systémo... more Súhrn Obezita dosahuje rozmery globálnej epidémie. Priamo prispieva k nárastu prevalencie systémových ochorení asociovaných s obezitou. Obezita a nadváha globálne spôsobia ročne 3,5 miliónov úmrtí [1]. Nealkoholová tuková choroba pečene sa stala najčastejším chronickým pečeňovým ochorením v rozvinutých krajinách a je považovaná za pečeňovú manifestáciu metabolického syndrómu. Rozsah a bremeno choroby stále rastie a dosahuje epidemické rozmery práve pre svoju úzku spojitosť s epidémiou obezity a diabetes mellitus 2. typu. Postihuje 30 % dospelej populácie [2]. Alarmujúci je nárast prevalencie u detí a mladistvých. V skupine pacientov s vysokým kardiometabolickým rizikom je prevalencia NAFLD významne vyššia. Prevalencia u obéznych pacientov dosahuje 75-92 %, prevalencia u diabetikov sa pohybuje medzi 60-70 % [3]. Významná časť pacientov s NAFLD bude trpieť progresívnou formou ochorenia-nealkoholovou steatohepatitídou (NASH), ktorá sa spája s rozvojom pokročilej pečeňovej fibrózy, cirhózy a jej komplikáciami. Rastúca prevalencia NASH v blízkej budúcnosti privedie do štádia pokročilej choroby pečene obrovskú kohortu našich pacientov. Ak sa nepodarí zvrátiť nepriaznivý epidemiologický trend, tak v nasledujúcej dekáde bude najčastejším dôvodom transplantácie pečene práve NASH. Neustále rastúci trend možno pozorovať v náraste počtu prípadov hepatocelulárneho karcinómu v kauzálnej súvislosti s NASH [4]. Liečba založená na ovplyvnení kľúčových patogenetických mechanizmov by mohla zmeniť individuálnu budúcnosť chorých, ale aj globálne bremeno vyplývajúce z NASH. Kľúčovú rolu v budúcnosti budú zohrávať nové molekuly s protizápalovým a antifibrotickým efektom. Kľúčové slová: cirhóza pečene-inzulínová rezistencia-metabolický syndróm-NASH Future of pharmacological treatment of non-alcoholic steatohepatitis in terms of key pathophysiological mechanisms Summary Obesity reaches the dimensions of the global epidemic. It directly contributes to an increase in the prevalence of systemic diseases associated with obesity. Obesity and overweight globally cause 3.5 million deaths annually [1]. Non-alcoholic fatty liver disease has become the most common chronic liver disease in developed countries and is considered to be a liver manifestation of metabolic syndrome. The extent and burden of the disease are increasing and reaching epidemic proportions because of its close association with the epidemic of obesity and diabetes mellitus type [2]. It affects 30 % of the adult population [2]. There is an alarming increase in prevalence among children and adolescents. However, in the group of patients with high cardiometabolic risk, we can see a significantly higher prevalence of NAFLD. Prevalence in obese patients is 75-92 %, in diabetic patients prevalence is between 60-70 % [3]. A significant proportion of patients with NAFLD will suffer from a progressive form of the disease-non-alcoholic steatohepatitis (NASH), which is associated with the development of advanced liver fibrosis, cirrhosis, and its complications. The growing prevalence of NASH in the near future will bring the advanced cohort of our patients to the stage of an advanced liver disease. If the adverse epidemiological trend is not reversed, in the next decade the most common cause of liver transplantation will be NASH. A steadily rising trend can be seen in an increase in the number of cases of hepatocellular carcinoma causally related to NASH [4]. Treatment based on the influence of key pathogenetic mechanisms could alter the individual's future as well as the global burden arising with NASH. New molecules with anti-inflammatory and antifibrotic effects will play a key role in the future.
Clinical and Experimental Hepatology, 2020
Aim of the study: We set out to determine the applicability of acute-on-chronic liver failure (AC... more Aim of the study: We set out to determine the applicability of acute-on-chronic liver failure (ACLF) diagnostic criteria and characteristics of thus defined ACLF sub-cohorts in a real-life clinical context. Material and methods: Retrospective charts' analysis of consecutive patients hospitalized with decompensated liver disease. Inclusion criteria: acute decompensation, informed consent. Exclusion criteria: malignancy. Diagnostic tools: 1 st phase-CLIF-SOFA score calculated manually; 2 nd phase-CLIF-C ACLF score calculated at www.efclif.com. Results: Of 432 hospitalized patients aged 52 years, 41% were female, with MELD 20, 32% patients had acute decompensation (AD); main triggers were alcoholic hepatitis (38%), infections (26%), and variceal bleeding (23%). Of patients with AD, ACLF grades 0-3 was present in 64%, 19%, 13%, and 4%, respectively. In hospital mortality according to final AD/ACLF grade in ACLF 0-3 was 7.5%, 42%, 47%, and 80%, respectively (p < 0.0001). Conclusions: Diagnosing ACLF is nowadays easy; it helps to stratify patients at admission, and refine risk stratification at day 7. The main trigger of AD/ACLF in this region is alcohol. Currently, there are no ACLF-specific treatments; however, timely intensive supportive care can influence the prognosis. Even though still elusive and controversial, the ACLF concept can help systematize management of patients admitted with acute decompensation of advanced chronic liver disease.
Gastroenterologie a Hepatologie, 2020
Central European Journal of Public Health, 2017
Aim: The economy of each state provides a significant amount of money into the health care system... more Aim: The economy of each state provides a significant amount of money into the health care system with the aim of knowing the health status of its population in the context of socioeconomic characteristics for effective resource allocation. In recent years, there is a growing number of cancer deaths in Slovakia. Therefore, the structure of cancer deaths according to its primary determinants, such as age, sex and education with the aim of effective implementation of prevention programs in Slovakia was examined. Methods: Main source of data on deaths from 1996 to 2014 was provided by National Health Information Centre in Slovakia. However, data were available only from 2011. Standardized mortality rate per 100,000 inhabitants was estimated by the method of direct standardization using European standard population. The R project for statistical computing was used for calculation of statistically significant differences among various groups of mortality. Results: The results show that people with primary education die from cancer later than people with higher education. However, major differences related to both sex and age are present in people with university education. A different variety of cancers occur in childhood (neoplasm of brain), adolescents (neoplasm of bone), young adults (neoplasm of brain), or adults (lung cancer and breast cancer). Malignant neoplasm of brain was more prevalent at higher education levels, Malignant neoplasm of bladder and Malignant melanoma of skin were more prevalent at the university level of education. Conclusions: The results can be useful for economists to define the health priorities in each country, make the financial decisions in economics, and thus contribute to better health, economic growth, as well as effective spending of health expenditures.
Introduction: Liver cirrhosis is associated with a poor quality of life (QOL). The SARS-CoV-2 cor... more Introduction: Liver cirrhosis is associated with a poor quality of life (QOL). The SARS-CoV-2 coronavirus pandemic has led to several restriction measures and psychosocial consequences whose impact on QOL has combined with that of cirrhosis in an unknown way. Therefore, we have used our cirrhosis registry to assess quality of life before the pandemic (at the first admission to the tertiary liver unit) and during the most pronounced phase of the first lockdown. Materials and Methods: In this cross-sectional study conducted during the first lockdown in Slovakia (from April to May 2020), we have repeated the QOL measurement of QOL in cirrhotic patients previously enrolled in the RH7 registry. Of the entire RH7 cohort, we have identified patients who were alive (according to the national registry of deaths) and contacted them by phone with a structured and standardized interview led by trained professionals. The tool used for both QOL measurements (at enrolment to RH7 and during the loc...
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Papers by Lubomir Skladany