International Multi-Specialty Delphi Survey: Identification of Diagnostic Criteria for Hepatic and Renal Cyst Infection

Abstract

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.

Two cases of fungal cyst infection in ADPKD: is this really a rare complication?

“…Previous studies propose that a definite diagnosis of CI should be based on cyst aspirate showing neutrophil debris and/or a pathogenic microorganism [6, 16]. With minor variations, a common algorithm defines as likely CI the presence of fever (temperature > 38.5 °C for > 3 days); abdominal pain (particularly a palpable area of renal or liver tenderness); CRP > 50 mg/L, and absence of recent, significant intracystic bleeding or other causes of fever [1, 3, 11, 16, 17]. Since positive cyst cultures are usually not available, likely CI is far more prevalent than definite CI in the clinical scenario.…”

Protocol for the development of a core indicator set for reporting burn wound infection in trials: ICon-B study

“…It has been used previously to establish consensus between experts about core outcomes to be assessed in various healthcare domains and has been found to improve consistency of outcome reporting between studies 24. This methodology has also been used to agree key diagnostic criteria for clinical conditions for which there is no objective diagnostic method, including for bone and joint infections in children25 and hepatic and renal cyst infection 26. It is important to note that the proposed methodology for developing the core indicator set is not intended to identify those indicators that are most predictive of BWI diagnosis.…”

Efficacy and safety of selective decontamination of the digestive tract (SDD) to prevent recurrent hepatic cyst infections in polycystic liver disease: a retrospective case series

“…Diagnosis was made by the treating physician involved, based on clinical, biochemical, microbiological and imaging criteria, in addition to response to antimicrobial treatment. 10 When hepatic cyst infection occurred within 1 month following the end of treatment of a previous cyst infection it was defined as: (i) persistence of the same infection when the cultured pathogen and resistance pattern matched with findings from the earlier infection; or (ii) as a new episode when different pathogens or distinct resistance patterns were found. Only those defined as (ii) were included in analyses.…”