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

Journal article

Background: The lack of international consensus on defining and categorising 

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, 

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.

Authors: Leston, M; Ordóñez-Mena, JM; Joy, M; Hobbs, FDR; de Lusignan, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: EClinicalMedicine
• Volume: 83
• Article number: 103239
• Publication date: 2025-05-05
• Acceptance date: 2025-04-18
• DOI: 10.1016/j.eclinm.2025.103239
• EISSN: 2589-5370
• Language: English
• Keywords: vaccine; immunosuppressed; immunosuppression; consensus; Delphi; public health; policy; digital health; COVID-19; policymaking; disease surveillance; pharmacovigilance; inoculation; personalised medicine; precision health; inclusion health