TY - JOUR
T1 - International Multi-Specialty Delphi Survey
T2 - Identification of Diagnostic Criteria for Hepatic and Renal Cyst Infection
AU - on behalf of the Delphi collaborators
AU - Lantinga, Marten A.
AU - Darding, Alexander J.M.
AU - De Sévaux, Ruud G.L.
AU - Alam, Ahsan
AU - Bleeker-Rovers, Chantal P.
AU - Bobot, Mickaël
AU - Cornec-Le Gall, Emilie
AU - Gevers, Tom J.G.
AU - Hassoun, Ziad
AU - Meijer, Esther
AU - Mrug, Michal
AU - Nevens, Frederik
AU - Onuchic, Luiz F.
AU - Pei, York
AU - Piccoli, Giorgina B.
AU - Pirson, Yves
AU - Rangan, Gopala K.
AU - Torra, Roser
AU - Visser, Folkert W.
AU - Jouret, François
AU - Kanaan, Nada
AU - Oyen, Wim J.G.
AU - Suwabe, Tatsuya
AU - Torres, Vicente E.
AU - Drenth, Joost P.H.
AU - Bennett, W. M.
AU - Chapman, A. B.
AU - Gansevoort, R. T.
AU - Everson, G. T.
AU - Gorriz, J. L.
AU - Hogan, M. C.
AU - Park, H. C.
AU - Soonawala, D.
AU - Watnick, T. J.
N1 - Publisher Copyright:
© 2016 S. Karger AG, Basel. All rights reserved.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background: Cyst infection is one of the complications of autosomal dominant polycystic kidney disease and polycystic liver disease. The diagnosis is typically made on a mix of clinical, laboratory and imaging abnormalities but the importance of individual items is uncertain. We aimed to perform a Delphi survey amongst physicians to achieve consensus on diagnostic criteria. Methods: We retrieved diagnostic items from the literature and conducted physician and patient interviews. All items were combined to create the online questionnaire. Participants rated each item during 3 consecutive rounds. Items were rated for diagnostic helpfulness for hepatic and renal cyst infection on a 9-point scale with anchors, from extremely unimportant (n = 1) to extremely important (n = 9). We determined consensus with the disagreement index. The median rating of each item was calculated and categorized into inappropriate (≤3.4), uncertain (3.5-6.4) or appropriate (≥6.5). By combining all items that reached an appropriate consensus rating, we developed a diagnostic algorithm based on expert consensus. Results: We invited 58 physicians to participate in the survey. In total, 35 (60%) responded to round 1 of which 91% (n = 32) and 86% (n = 30) responded to round 2 and 3, respectively. The final panel included 23 nephrologists, 5 hepatologists, a nuclear medicine specialist and an infectious disease physician from 11 countries (male 67%, mean age 47 ± 11 years, median clinical experience 21 years). The panel rated the diagnostic helpfulness of 59 potential items. Ultimately, 22 hepatic and 26 renal items were rated appropriate, including positive blood cultures and fluorodeoxyglucose positron-emission CT imaging. Ultrasonography and absence of intracystic bleeding were amongst those deemed uncertain or inappropriate. Subsequently, by combining items rated appropriate, we developed a clinical tool to diagnose hepatic and renal cyst infection. Conclusions: We identified diagnostic items for hepatic and renal cyst infection and developed an expert-based diagnostic algorithm, which may aid physicians in the diagnostic work-up. A prospective study is necessary to validate this algorithm.
AB - Background: Cyst infection is one of the complications of autosomal dominant polycystic kidney disease and polycystic liver disease. The diagnosis is typically made on a mix of clinical, laboratory and imaging abnormalities but the importance of individual items is uncertain. We aimed to perform a Delphi survey amongst physicians to achieve consensus on diagnostic criteria. Methods: We retrieved diagnostic items from the literature and conducted physician and patient interviews. All items were combined to create the online questionnaire. Participants rated each item during 3 consecutive rounds. Items were rated for diagnostic helpfulness for hepatic and renal cyst infection on a 9-point scale with anchors, from extremely unimportant (n = 1) to extremely important (n = 9). We determined consensus with the disagreement index. The median rating of each item was calculated and categorized into inappropriate (≤3.4), uncertain (3.5-6.4) or appropriate (≥6.5). By combining all items that reached an appropriate consensus rating, we developed a diagnostic algorithm based on expert consensus. Results: We invited 58 physicians to participate in the survey. In total, 35 (60%) responded to round 1 of which 91% (n = 32) and 86% (n = 30) responded to round 2 and 3, respectively. The final panel included 23 nephrologists, 5 hepatologists, a nuclear medicine specialist and an infectious disease physician from 11 countries (male 67%, mean age 47 ± 11 years, median clinical experience 21 years). The panel rated the diagnostic helpfulness of 59 potential items. Ultimately, 22 hepatic and 26 renal items were rated appropriate, including positive blood cultures and fluorodeoxyglucose positron-emission CT imaging. Ultrasonography and absence of intracystic bleeding were amongst those deemed uncertain or inappropriate. Subsequently, by combining items rated appropriate, we developed a clinical tool to diagnose hepatic and renal cyst infection. Conclusions: We identified diagnostic items for hepatic and renal cyst infection and developed an expert-based diagnostic algorithm, which may aid physicians in the diagnostic work-up. A prospective study is necessary to validate this algorithm.
KW - Autosomal dominant polycystic kidney disease
KW - Diagnosis
KW - Infection
KW - Polycystic kidney disease
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UR - http://www.scopus.com/inward/citedby.url?scp=84986579415&partnerID=8YFLogxK
U2 - 10.1159/000446664
DO - 10.1159/000446664
M3 - Article
C2 - 27599120
AN - SCOPUS:84986579415
SN - 1660-8151
VL - 134
SP - 205
EP - 214
JO - Nephron
JF - Nephron
IS - 4
ER -