1. SMOKING AND HISTOLOGICAL STAGE OF CHRONIC VIRAL HEPATITIS
E Tsochatzis1, N Chrysanthos1, EK Manesis1,
GV Papatheodoridis1, G Kafiri2, J Archimandritis1.
12nd Department of Internal Medicine, Athens University Medical School;
2Pathology Department, Hippokration General Hospital, Athens, Greece.

2. INTRODUCTION AIM Recent data support a possible relationship of
smoking with more severe necroinflammatory
activity and perhaps fibrosis in patients with chronic
hepatitis C (CH-C), while there are no relevant data
in patients with chronic hepatitis B (CH-B).
The mechanism of this relationship is unclear and the
only existing data comes from mice, where nicotine
induces liver injury through oxidative stress.
AIM
To assess the possible associations of smoking habits with histological lesions in patients with CH

3. PATIENTS Exclusion criteria:
250 patients with CH admitted to our Department for liver biopsy
(CH-C: 165, HBeAg-negative CH-B: 85)
Exclusion criteria:
malignant tumors
antiviral/immunomodulatory treatment within
the last six months

4. METHODS Histological evaluation Clinical – Laboratory Evaluation
Epidemiological, anthropometric and disease characteristics
Smoking habits
Alcohol consumption
Hb, Ht, PLT, WBC
Chemistry laboratory values
PT, aPTT, INR
Histological evaluation
All biopsies were randomly evaluated by a liver pathologist
according to Ishak’s classification (Ishak et al 1995)

5. Table 1. Baseline patient characteristics
Sex, males (%) (55)
Age (years) ±15 (18-79)
Body mass index ±3.6 ( )
Type of CH, CH-C, n (%) (66)
Smoking status, n
Never/former smokers (70)
Current smokers (30)
Tobacco consumption (pack-years) ±14.9 (0-75)
Pack-years, n (%)
(70)
(16)
> (14)

6. Daily alcohol consumption, g 23±47 (0-365)
Alcohol abuse, n (%) (20)
PLT (x10³/L) ±85 (56-731)
AST (IU/L) ±75 (9-722)
ALT (IU/L) ±97 (12-647)
γGT (IU/L) ±134 (4-1963)
Necroinflammatory activity, n (%)
Mild (score 3-8) (64)
Moderate/Severe (score 9-18) (36)
Fibrosis, n (%)
Stage (60)
Stage (40)

7. Table 2. Epidemiological and laboratory features of 250 patients with CH-Β or –C in association with necroinflammatory activity
Grading Grading 9-18
(N=161) (N=89) P
Type of CH, HCV/HBV / /
Age (years) ± ±
Sex, M (%) (56) (53)
Mean alcohol consumption 23± ±
Pack-years, n (%)
(65) (80)
(18) (10)
> (17) (10)
PLT (x109/L) ± ±
ALT (IU/L) ± ±
AST (IU/L) ± ± <0.001
GGT (IU/L) ± ±
Fibrosis score ± ± <0.001

8. Table 3. Epidemiological and laboratory features of 250 patients with CH-Β or –C in association with fibrosis stage
Stage Stage 4-6
(N=149) (N=101) P
Type of CH, HCV/HBV / /
Age (years) ± ± <0.001
Sex, M (%) (52) (58) Mean alcohol consumption ± ±
Pack-years, n (%)
(66) (76)
(19) (11)
> (15) (13)
PLT (x109/L) ± ± <0.001
ALT (IU/L) ± ±
AST (IU/L) ± ±
GGT (IU/L) ± ±
Grading score ± ± <0.001

9. Figure 1. Smoking and necroinflammatory activity of CΗ
Ρ=0.043
Patients, %
Non smokers pack/years >20 pack/years

10. Figure 2. Smoking and histological stage of CΗ
Ρ=0.15
Patients, %
Non smokers pack/years >20 pack/years

11. Figure 3. Age and histological stage of CΗ
Ρ<0.001
Patients, %
<30 yrs yrs yrs yrs >61 yrs

12. Table 4. Multivariate analysis of factors associated with necroinflammatory activity in univariate analysis
P – Multivariate OR (95% CI)
Age (years)
AST (IU/L) ( )
Fibrosis score ( )
Pack-years
(0/1-20/>20)

13. Table 5. Multivariate analysis of factors associated with fibrosis stage in univariate analysis
P – Multivariate OR (95% CI)
Age (years) ( )
AST (IU/L)
Necroinflammatory activity ( )
PLT (x109/L)
γGT (IU/L)

14. CONCLUSIONS
In patients with CΗ-C or HΒeAg-negative CΗ-Β, smoking habits do not seem to be associated with the severity of liver histological lesions