Defining and Risk-Stratifying Immunosuppression (the DESTINIES Study): Protocol for an Electronic Delphi Study

Area of Science:

• Immunology and Infectious Disease Epidemiology
• Clinical Informatics and Digital Health

Background:

• Inconsistent definitions of immunosuppression hinder global disease surveillance and patient care, particularly for COVID-19.
• Conflicting clinical definitions during the COVID-19 pandemic created disparities in monitoring and managing immunosuppressed populations.
• A need exists for international consensus on immunosuppression criteria and severity gradations for improved public health responses.

Purpose of the Study:

• To demonstrate how electronic Delphi methodology can achieve international consensus on adult immunosuppression.
• To develop a COVID-19 risk-stratified digital phenotype for adult immunosuppression.
• To address the lack of standardized definitions impacting patient care and surveillance.

Main Methods:

• Recruitment of over 50 global experts in immunology and clinical risk prioritization.
• Utilizing a 2-round electronic Delphi consensus-building process with a final debate.
• Iterative refinement of questionnaires based on expert feedback and statistical analysis of agreement levels.

Main Results:

• A robust protocol for consensus on adult immunosuppression definitions and COVID-19 risk stratification has been outlined.
• Panelist recruitment exceeded the target, with over 50 experts engaged.
• Data collection is underway, projected for completion in July 2024.

Conclusions:

• Successful implementation will yield a universally accepted, clinically relevant phenotype for adult immunosuppression.
• The phenotype will be compatible with electronic health records, enhancing data utility.
• This work offers prospective value for managing various diseases affecting immunosuppressed populations beyond COVID-19.