Peripheral Blood Eosinophilia at Diagnosis of Inflammatory Bowel Disease Is Associated With Severe Disease Course: A Nationwide Study From the epi-IIRN Cohort - Report - MDSpire
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Peripheral Blood Eosinophilia at Diagnosis of Inflammatory Bowel Disease Is Associated With Severe Disease Course: A Nationwide Study From the epi-IIRN Cohort
Peripheral Blood Eosinophilia Predicts Severe Progression in Inflammatory Bowel Disease
Overview
This nationwide cohort study of over 28,000 IBD patients found that peripheral blood eosinophilia (PBE) at diagnosis is significantly associated with a more severe disease course, including corticosteroid dependency, biologic use, hospitalization, and surgery. PBE was more prevalent in ulcerative colitis and pediatric-onset IBD and independently predicted adverse long-term outcomes.
Background
Inflammatory bowel diseases (IBDs) are chronic immune-mediated disorders involving multiple immune cells, including eosinophils, which contribute to mucosal inflammation and tissue remodeling. Peripheral blood eosinophilia (PBE) has been observed in IBD patients, but its prognostic significance remains controversial. Prior studies have shown conflicting results regarding the association of PBE with disease activity and outcomes. This large-scale, population-based study aimed to clarify the relationship between PBE at diagnosis and long-term disease progression in both pediatric and adult IBD patients.
Data Highlights
Parameter
IBD Patients (n=28,133)
Non-IBD Controls (n=28,724)
p-value
Prevalence of PBE (>0.5 × 10⁹/L)
13%
5%
<0.001
PBE Prevalence in UC
16.1%
PBE Prevalence in CD
10.6%
Odds Ratio (UC vs CD for PBE)
1.52 (95% CI 1.42-1.63)
<0.001
PBE Prevalence Pediatric-onset IBD
23.5%
PBE Prevalence Adult-onset IBD
11%
Odds Ratio (Pediatric vs Adult for PBE)
2.14 (95% CI 1.97-2.31)
<0.001
Hazard Ratio for Severe Disease Course with PBE
1.49 (95% CI 1.38-1.62)
<0.001
Hazard Ratio for Hospitalization
1.24 (95% CI 1.19-1.30)
Hazard Ratio for Corticosteroid Use
1.32 (95% CI 1.28-1.36)
Hazard Ratio for Corticosteroid Dependency
1.37 (95% CI 1.31-1.43)
Hazard Ratio for Biologic Use
1.27 (95% CI 1.21-1.33)
Key Findings
Peripheral blood eosinophilia (PBE) at IBD diagnosis was present in 13% of patients versus 5% in matched non-IBD controls (p < 0.001).
PBE was significantly more common in ulcerative colitis (16.1%) than Crohn’s disease (10.6%) with an OR of 1.52 (95% CI 1.42-1.63).
Pediatric-onset IBD patients had a higher prevalence of PBE (23.5%) compared to adult-onset patients (11%), OR 2.14 (95% CI 1.97-2.31).
In multivariate analysis, PBE independently predicted a severe disease course (HR 1.49, 95% CI 1.38-1.62, p < 0.001).
PBE was associated with increased risk of hospitalization (HR 1.24), corticosteroid use (HR 1.32), corticosteroid dependency (HR 1.37), and need for biologic therapy (HR 1.27).
These associations persisted after excluding patients with allergic conditions or anti-allergic medication use, supporting PBE as an independent marker of IBD severity.
Clinical Implications
Peripheral blood eosinophilia at the time of IBD diagnosis can serve as a readily available biomarker to identify patients at higher risk for severe disease progression. Clinicians should consider closer monitoring and potentially earlier aggressive therapy in patients presenting with PBE. Furthermore, PBE may represent a novel therapeutic target to improve long-term outcomes in IBD.
Conclusion
This large nationwide study demonstrates that peripheral blood eosinophilia at diagnosis is a significant predictor of severe disease course in both pediatric and adult IBD patients. Incorporating PBE assessment into routine clinical evaluation may enhance risk stratification and guide personalized management strategies.
References
Epidemiology Group of the Israeli IBD Research Nucleus (epi-IIRN) 2024 -- Association of Peripheral Blood Eosinophilia at IBD Diagnosis with Severe Disease Progression
Large claims analysis finds no significant differences in serious infections, blood clots, or major cardiovascular events across biologics and a Janus kinase inhibitor.
