The role of CARD15 mutations and smoking in the course of Crohn's disease in a Mediterranean area.
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.
Renda
Maria Concetta
MC
Ematologia II Ospedale V. Cervello, Palermo, Italy.
Orlando
Ambrogio
A
Civitavecchia
Giuseppe
G
Criscuoli
Valeria
V
Maggio
Aurelio
A
Mocciaro
Filippo
F
Rossi
Francesca
F
Scimeca
Daniela
D
Modesto
Irene
I
Oliva
Lorenzo
L
Cottone
Mario
M
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*
D053473:Nod2 Signaling Adaptor Protein