Can peripheral blood eosinophils predict primary non-response to Infliximab therapy in pediatric Crohn’s disease?

• This study demonstrated that peripheral blood eosinophils at baseline of treatment could predict PNR to IFX therapy. • Our predictive model is economical and convenient. • Provides theoretical support for the role of eosinophils in the treatment of Crohn's disease. The aim of this study was to assess whether peripheral blood eosinophils can predict primary non-response in pediatric Crohn’s disease on infliximab therapy. A total of 37 patients diagnosed with Crohn’s disease who had received infliximab induction between 2018 and 2022 were enrolled in this study. Clinical and other laboratory data were collected at baseline of infliximab therapy. Primary non-response was determined at week 14. The Mann-Whitney U test and t-test were used to evaluate correlation of variables at baseline with primary non-response at week 14. Multivariable logistic regression was used to construct prediction models. The Area Under Curve of the receiver operating characteristic curve was calculated. Primary non-response occurred in 27% patients who were assessable at week 14. Analysis of baseline clinical data and laboratory data showed that disease duration (P = 0.003), neutrophils (P = 0.013), lymphocyte (P = 0.003), eosinophils (P = 0.013), albumin (P = 0.001) and total bilirubin (P = 0.028) correlated with primary non-response at week 14. Multiple logistic regression withheld three final independent predictors for primary non-response: disease duration (1.49, 95%CI 1.01-2.21, P = 0.046), neutrophils (2.30, 95%CI 1.02–5.19, P = 0.044), and eosinophils at first infliximab (0.97, 95%CI 0.93–1.02, P = 0.019). The validated model containing peripheral blood eosinophils showed excellent discrimination to primary non-response with an Area Under Curve of 0.974. Peripheral blood eosinophils are promising biomarkers in prediction of primary non-response to infliximab and may be useful for guiding physicians in therapeutic decision-making.