title: The role of CARD15 mutations and smoking in the course of Crohn's disease in a Mediterranean area.
abstract: OBJECTIVE
  To evaluate the role of CARD15 mutations and smoking in the main events of Crohn's disease (CD).
  
  
  METHODS
  A total of 182 patients with CD were included in a prospective study in order to evaluate the role of CARD15 mutations and smoking in the main outcomes of disease course: first operation and surgical recurrence. The following variables were evaluated in a univariable and multivariable analysis: age, sex, site of disease, pattern, smoking habit, extraintestinal manifestations, duration of disease, and CARD15 mutation. The Kaplan-Meier method for survival curves and Cox model for multivariable analysis were, respectively, used.
  
  
  RESULTS
  A total of 110 patients were operated on and 32 were reoperated on. The 7-yr cumulative free rate of surgery was 42% (95% CI 34-51%). At multivariate analysis only stricturing and penetrating pattern were predictors of surgery (HR 1.7, 95% CI 1-2.8; HR 3.2, CI 1.8-5.5, respectively). The 7-yr cumulative free rate of reoperation was 75% (95% CI 0.52-0.88). At multivariable analysis in the model with any CARD15 mutation, only smoking habit at diagnosis (HR 3.6, 95% CI 1.4-9.1) was predictive of surgical recurrence. When single mutations were considered in the model smoking (HR 4.2, 95% CI 1.8-10.1) and L1007fs mutation (HR 2.9, 95% CI 1.1-7.3) were predictive of reoperation.
  
  
  CONCLUSIONS
  In CD, smoking predicts recurrence after surgery. The role of CARD15 mutations in the clinical course of CD remains undefined.
authors.affiliation: Ematologia II Ospedale V. Cervello, Palermo, Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Renda
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Orlando
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Civitavecchia
authors.forename: Valeria
authors.initials: V
authors.lastname: Criscuoli
authors.forename: Aurelio
authors.initials: A
authors.lastname: Maggio
authors.forename: Filippo
authors.initials: F
authors.lastname: Mocciaro
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossi
authors.forename: Daniela
authors.initials: D
authors.lastname: Scimeca
authors.forename: Irene
authors.initials: I
authors.lastname: Modesto
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Oliva
authors.forename: Mario
authors.initials: M
authors.lastname: Cottone
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D009154:Mutation; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics*; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012907:Smoking / Q000009:adverse effects*
chemical_list: D053473:Nod2 Signaling Adaptor Protein