TY - JOUR
AU - Leston, Meredith
AU - Ordóñez-Mena, José M.
AU - Joy, Mark
AU - de Lusignan, Simon
AU - Teh, Benjamin W.
AU - de Groot, Ingrid
AU - McInnes, Iain B.
AU - El Sahly, Hana M.
AU - Isaacs, John D.
AU - Andersson, Monique
AU - Raffi, Francois
AU - Lim, Wei Shen
AU - Conway, Richard
AU - Siebert, Stefan
AU - Buchan, Iain
AU - Underwood, Martin
AU - Lowe, David
AU - Hoerger, Michael
AU - Griffiths, Christopher E.M.
AU - Alunno, Alessia
AU - Lee, Lennard Y.W.
AU - Hobbs, F.D. Richard
PY - 2025
DA - May
TI - The DESTINIES Study: an online Delphi study to build international consensus on the medical conditions and procedures that confer immunosuppression and their respective COVID-19 risk profiles
JO - eClinicalMedicine
VL - 83
DO - http://dx.doi.org/10.1016/j.eclinm.2025.103239
AB - Background: The lack of international consensus on defining and categorising immunosuppression has undermined disease surveillance and patient care, particularly during the COVID-19 pandemic. To address this, a global expert panel was recruited to join the eDElphi STudy to fully defiINe and COVID-risk stratify ImmunosupprESsion (DESTINIES) and develop a COVID risk-stratified digital phenotype for ‘adult immunosuppression’ (the DESTINIES phenotype). Methods: Panellists were presented with all medical diagnoses and procedures cited in prevailing immunosuppressed definitions; they evaluated their appropriateness for the DESTINIES phenotype and their risks for severe COVID-19 outcomes through anonymous online questionnaires and discussion. Panel agreement with a series of clinical statements were also assessed; statements incorporated longstanding disputes, including variables that could reverse immunosuppression. Each round of data collection informed and refined a draft phenotype until final ratification. This study was active between May and September 2024. Findings: Sixty-four experts from four continents and 12 international agencies completed two rounds of consensus questionnaire, a discussion group and ratifying vote. Panellists identified candidates posing higher (e.g. Transplantation, Primary Immunodeficiency) and lower COVID-19 risk (e.g. Anorexia nervosa, Cerebral spinal fluid leak) but disagreed on the categorisation of others (e.g. Asplenia, Immune-mediated Inflammatory Disease). Consensus was reached on ten clinical statements, notably removing Drug-managed HIV and Cancer remission from consideration as immunosuppressed. The DESTINIES phenotype was ratified with near unanimous support (94%) for implementation in surveillance. Interpretation: Pending validation, the DESTINIES phenotype provides a clinically meaningful, internationally ratified and digitally practical method for identifying and COVID-19 risk-stratifying adult immunosuppressed patients in healthcare data.
PB - Elsevier
UR - https://eprints.gla.ac.uk/355622/
KW - Coronavirus (COVID-19)
KW - Immunisation and screening
KW - Digital health and technology
ER