Persistent Eosinophilia in Inflammatory Bowel Disease Patients Is Associated with Poorer Long Term Clinical Outcomes

Introduction: Peripheral blood eosinophilia (PBE) has been shown to be a marker of worse outcomes and increased medical costs in inflammatory bowel disease (IBD) patients. It is hypothesized that eosinophils might serve as a marker for IBD outcomes. We describe real world outcomes in IBD pts with PBE and assess effects of persistent PBE. Methods: A prospectively collected clinical database was queried to identify IBD pts with at least 5 years of clinical follow up at our tertiary care center. Demographic, disease type, phenotype, and duration were collected on each pt. Charts were then reviewed for pts that did and did not have PBE during the past 5 years follow up. PBE was defined as >0.45 x 10ˆ3μL at any point during follow up. Pts with more than one episode of PBE were characterized as persistent PBE (PPBE). The clinical course of the two groups were compared against normal pts for mean health related quality of life by SIBDQ scores, mean HBI, UC disease activity index (UCDAI) scores, hospitalizations, surgeries and anti TNF usage over 5 years.Table 1: Demographic and Results for patients with PBEResults: 645 patients with 5 or more years of follow up. 501 (77%) were CD and 373 (57%) were female. All had at least one eosinophil count at the time of last follow up. A total of 84 (13%) pts had elevated PBE, a similar percentage of UC 12.5% and CD 13.2% had PBE. When compared to patients without PBE pts with PBE had similar demographics and disease characteristics. Pts with PBE had lower SIBDQ scores (50.1 v. 52.6 p=0.03) and higher mean HBI/UCDAI (3.1v. 2.3 p=0.003) than those without PBE. Pts with PBE were more likely to be hospitalized (64.2% vs. 46.4%, p=0.002) and to be on anti-TNF therapy (67.8% vs. 55.7%, p=0.037) than non PBE pts However, the rates of surgeries did not differ between the two groups. These associations were even more pronounced in pts with PPBE (n=60) compared to normal: SIBDQ (48.9 vs. 52, p=0.003), HBI/UCDAI (3.3 vs. 2.3, p=0.00), need for hospitalization (68.3% vs. 46.3 %, p=0.001) & need for anti-TNF (77.7% vs. 55.8%). Conclusion: PBE in IBD pts is associated with a worse health related quality of life, increase disease activity and overall worse clinical outcomes over long term follow up. These associations are even more pronounced in IBD pts with persistent PBE suggesting greater vigilance in this patient population. Additional research is needed to better understand this unique sub-set of IBD patients.