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Peripheral Blood Eosinophilia and Long-term Severity in Pediatric-Onset Inflammatory Bowel Disease
Krishnapriya Marangattu Prathapan1, Claudia Ramos Rivers2, Alyce Anderson3
1Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Peripheral blood eosinophilia (PBE) is more common in adults with pediatric-onset inflammatory bowel diseases (IBD). This finding suggests PBE may identify a high-risk group with long-term disease severity and higher healthcare costs.
Area of Science:
- Gastroenterology
- Immunology
- Pediatric Medicine
Background:
- Peripheral blood eosinophilia (PBE) is linked to aggressive disease in adult inflammatory bowel diseases (IBD).
- PBE at diagnosis correlates with higher disease activity in pediatric-onset IBD.
- The study investigated PBE as a long-term severity biomarker in pediatric-onset IBD patients into adulthood.
Purpose of the Study:
- To determine if PBE serves as a biomarker for long-term disease severity in pediatric-onset IBD patients followed into adulthood.
- To compare PBE prevalence in pediatric-onset versus adult-onset IBD.
- To identify clinical characteristics and healthcare utilization associated with PBE in IBD.
Main Methods:
- Analysis of a prospective IBD registry (2009-2018) at an adult tertiary center.
- Evaluation of PBE prevalence in pediatric- and adult-onset IBD cohorts.
- Comparison of demographics, clinical data, and healthcare utilization between patients with and without PBE.
Main Results:
- PBE was found in 34% of pediatric-onset IBD patients versus 26.8% of adult-onset IBD patients (P < 0.001).
- In pediatric-onset IBD, PBE was associated with higher allergy rates (P < 0.0001).
- In adult IBD patients with pediatric-onset disease, PBE correlated with elevated inflammatory markers, increased healthcare utilization, and higher annual healthcare charges (P < 0.00001).
Conclusions:
- PBE is more prevalent in adult IBD patients with pediatric-onset disease.
- PBE identifies a subgroup of IBD patients with more severe illness and higher healthcare costs.
- PBE may serve as a biomarker for a high-risk subgroup in pediatric-onset IBD with persistent long-term severity into adulthood.
Background:
Peripheral blood eosinophilia (PBE) is a biomarker of an aggressive multiyear natural history in adults with inflammatory bowel diseases (IBDs). Additionally, PBE at diagnosis is associated with higher disease activity in pediatric-onset IBD. We sought to determine if PBE can function as a biomarker of long-term disease severity in pediatric-onset IBD patients who are followed into adulthood.
Methods:
We analyzed a consented, prospective, natural history IBD registry at an adult tertiary center from 2009 to 2018. Prevalence of PBE was evaluated in both pediatric- and adult-onset IBD patients. Demographics, clinical characteristics, and health care utilization data were compared in patients with and without PBE.
Results:
Among 2800 adult IBD patients, 23.4% had pediatric-onset disease. PBE was found in 34% of the pediatric-onset patients compared with 26.8% of the adult-onset IBD patients (P < 0.001). In the pediatric-onset IBD cohort, PBE was associated with higher rates of allergies (P < 0.0001), but not of asthma, allergic rhinitis, or primary sclerosing cholangitis. In the adult IBD patients with pediatric-onset disease, PBE was associated with higher rates of C-reactive protein elevation (P < 0.0001), erythrocyte sedimentation rate elevation (P < 0.0001), higher health care utilization, and higher average health care charges per year (P < 0.00001).
Conclusions:
Peripheral blood eosinophilia was more prevalent in adult IBD patients with pediatric-onset compared with adult-onset disease. Among all IBD patients with long-term follow-up, PBE defined a subgroup with more severe illness. These data suggest that PBE may be a biomarker for a high-risk subgroup with high cost trajectory and long-term severity in pediatric-onset IBD that persists into adulthood.
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