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
- Author(s)
- Leston, M; Ordóñez-Mena, JM; Joy, M; Hobbs, FDR; de Lusignan, S; Teh, BW; de Groot, I; McInnes, I; El Sahly, HM; Isaacs, J; Andersson, M; Raffi, F; Lim, WS; Conway, R; Siebert, S; Buchan, I; Underwood, M; Lowe, D; Hoerger, M; Griffiths, CEM; Alunno, A; Lee, LYW; DESTINIES Consortium;
- Journal Title
- eClinicalMedicine
- Publication Type
- Research article
- Abstract
- 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. FUNDING: This work was funded by the UK Medical Research Council and EMIS Health.
- Publisher
- eLife Sciences Publications
- Keywords
- Covid-19; Consensus; Delphi; Digital health; Disease surveillance; Immunosuppressed; Immunosuppression; Inclusion health; Inoculation; Personalised medicine; Pharmacovigilance; Policy; Policymaking; Precision health; Public health; Vaccine
- Department(s)
- Infectious Diseases
- Publisher's Version
- https://doi.org/10.1016/j.eclinm.2025.103239
- Open Access at Publisher's Site
https://doi.org/10.1016/j.eclinm.2025.103239- Terms of Use/Rights Notice
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Creation Date: 2025-06-26 04:30:32
Last Modified: 2025-06-26 04:31:07