What is the clinical evidence from this study?

Study design: Cohort. Population: Idiopathic hypereosinophilia (IHE) or hypereosinophilic syndrome (HES) with concurrent venous thromboembolism (VTE) (n=63). Intervention: Peak absolute eosinophil count >6.2 × 10^9/L vs. Peak absolute eosinophil count ≤6.2 × 10^9/L. Primary outcome: Development of pulmonary embolism (PE) (OR 5.55, 95% CI 1.292-23.875, p=0.021).

May 20, 2020Open Access

Hypereosinophilia with Concurrent Venous Thromboembolism: Clinical Features, Potential Risk Factors, and Short-term Outcomes in a Chinese Cohort

YLYecheng LiuChinese Academy of Medical Sciences & Peking Union Medical College XMXu MengChinese Academy of Medical Sciences & Peking Union Medical College JFJun FengDalian Ocean University

Key Result

In patients with hypereosinophilia and deep vein thrombosis, a peak absolute eosinophil count >6.2 × 10^9/L was independently associated with an increased risk of pulmonary embolism (OR 5.55).

Study Design

Type

Cohort (n=63)

Multicenter

Structured PICO

Population

63 adult patients (mean age 40.9 years, 17.5% female) with idiopathic hypereosinophilia or hypereosinophilic syndrome and concurrent venous thromboembolism, followed for a mean of 4.2 months.

Exposure

Corticosteroids and anticoagulants

Outcome

Short-term outcomes including hypereosinophilia remission rate, recurrent VTE, and major bleeding at 3 to 6 months after discharge, and risk factors for pulmonary embolism (PE).

In patients with hypereosinophilia and DVT, higher BMI, higher peak absolute eosinophil count, and longer duration of hypereosinophilia are independent risk factors for pulmonary embolism.

Main Result

Odds Ratio: 5.55 (95% CI 1.292–23.875)

p-value: p=0.021

Limitations

Retrospective study design with inevitable selection bias, such as admission bias
Some cases of HES may have been misdiagnosed as IHE because of lack of pathologic evidence of eosinophilic infiltration
Long time span of patient inclusion (1998 to 2018) with more than half of the patients lost to follow-up, preventing long-term outcome analysis

Abstract

Abstract Idiopathic hypereosinophilia (IHE) and hypereosinophilic syndrome (HES) are benign haematological disorders. Studies have suggested that venous thromboembolism (VTE) is a rare but sometimes fatal complication of hypereosinophilia; however, data are limited. We retrospectively analysed clinical features and short-term outcomes of 63 consecutive patients (82.5% men; mean age, 40.92 ± 10.89 years) with IHE or HES with concurrent VTE from January 1998 through December 2018. Risk factors for pulmonary embolism (PE) were explored by multivariate logistic analysis. DVT and/or PE was detected by imaging in all patients. Independent risk factors for PE were a body mass index of >24.1 kg/m 2 (odds ratio OR: 5.62, 95% confidence interval CI: 1.21–26.13, P = 0.028), peak absolute eosinophil count of >6.3 × 10 9 /L (OR: 5.55, 95% CI: 1.292–23.875, P = 0.021), and >13.9-month duration of hypereosinophilia (OR: 4.51, 95% CI: 1.123–18.09, P = 0.034). All patients were treated with corticosteroids and anticoagulants. The short-term hypereosinophilia remission rate was 100%; no recurrent VTE or major bleeding was observed. Hypereosinophilia is a potential risk factor for VTE. PE in patients with IHE/HES and DVT is associated with a higher body mass index, higher peak absolute eosinophil count, and longer duration of hypereosinophilia. Corticosteroids and anticoagulants provided effective short-term control of hypereosinophilia and VTE.

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