International Multi-Specialty Delphi Survey: Identification of Diagnostic Criteria for Hepatic and Renal Cyst Infection.
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.
Marten A
MA
Lantinga
Alexander J M
AJ
Darding
Ruud G L
RG
de Sévaux
Ahsan
A
Alam
Chantal P
CP
Bleeker-Rovers
Mickaël
M
Bobot
Emilie
E
Cornec-Le Gall
Tom J G
TJ
Gevers
Ziad
Z
Hassoun
Esther
E
Meijer
Michal
M
Mrug
Frederik
F
Nevens
Luiz F
LF
Onuchic
York
Y
Pei
Giorgina B
GB
Piccoli
Yves
Y
Pirson
Gopala K
GK
Rangan
Roser
R
Torra
Folkert W
FW
Visser
François
F
Jouret
Nada
N
Kanaan
Wim J G
WJ
Oyen
Tatsuya
T
Suwabe
Vicente E
VE
Torres
Joost P H
JP
Drenth
D000328:Adult; D000465:Algorithms; D003560:Cysts / Q000150:complications*; D003697:Delphi Technique; D003936:Diagnosis, Computer-Assisted; D005104:Expert Testimony; D005260:Female; D005762:Gastroenterology; D006505:Hepatitis / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009393:Nephritis / Q000175:diagnosis* / Q000209:etiology*; D009398:Nephrology; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications*