Clinical management of liver cyst infections: an international, modified Delphi-based clinical decision framework

Renée Duijzer; Lucas H P Bernts; Anja Geerts; Bart van Hoek; Minneke J Coenraad; Chantal Rovers; Domenico Alvaro; Ed J Kuijper; Frederik Nevens; Jan Halbritter; Jordi Colmenero; Juozas Kupcinskas; Mahdi Salih; Marie C Hogan; Maxime Ronot; Valerie Vilgrain; Nicolien M Hanemaaijer; Patrick S Kamath; Pavel Strnad; Richard Taubert; Ron T Gansevoort; Roser Torra; Silvio Nadalin; Tatsuya Suwabe; Tom J G Gevers; Vincenzo Cardinale; Joost P H Drenth; Marten A Lantinga

doi:10.1016/S2468-1253(24)00094-3

Clinical management of liver cyst infections: an international, modified Delphi-based clinical decision framework

Lancet Gastroenterol Hepatol. 2024 Sep;9(9):884-894. doi: 10.1016/S2468-1253(24)00094-3. Epub 2024 Jun 12.

Authors

Renée Duijzer¹, Lucas H P Bernts², Anja Geerts³, Bart van Hoek⁴, Minneke J Coenraad⁴, Chantal Rovers⁵, Domenico Alvaro⁶, Ed J Kuijper⁷, Frederik Nevens⁸, Jan Halbritter⁹, Jordi Colmenero¹⁰, Juozas Kupcinskas¹¹, Mahdi Salih¹², Marie C Hogan¹³, Maxime Ronot¹⁴, Valerie Vilgrain¹⁴, Nicolien M Hanemaaijer², Patrick S Kamath¹⁵, Pavel Strnad¹⁶, Richard Taubert¹⁷, Ron T Gansevoort¹⁸, Roser Torra¹⁹, Silvio Nadalin²⁰, Tatsuya Suwabe²¹, Tom J G Gevers²², Vincenzo Cardinale²³, Joost P H Drenth²⁴, Marten A Lantinga²⁵

Affiliations

¹ Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands.
² Department of Medical Microbiology, Radboudumc, Nijmegen, Netherlands.
³ Department of Hepatology and Gastroenterology, Ghent University, Ghent, Belgium; European Reference Network RARE-LIVER, Hamburg, Germany.
⁴ Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands.
⁵ Department of Internal Medicine, Radboudumc, Nijmegen, Netherlands.
⁶ Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
⁷ Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands.
⁸ European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium.
⁹ Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁰ European Reference Network RARE-LIVER, Hamburg, Germany; Liver Unit, Hospital Clinic Barcelona, IDIBAPS-FRCB, CIBERehd, University of Barcelona, Barcelona, Spain.
¹¹ European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
¹² Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, Rotterdam, Netherlands.
¹³ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
¹⁴ European Reference Network RARE-LIVER, Hamburg, Germany; Service de Radiologie, Hôpital Beaujon, APHP Nord, Clichy & Université Paris Cité, CRI, UMR 1149, Paris, France.
¹⁵ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
¹⁶ European Reference Network RARE-LIVER, Hamburg, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
¹⁷ European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
¹⁸ Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
¹⁹ Inherited Kidney Disorders, Department of Nephrology, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁰ Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany.
²¹ Nephrology Center, Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan.
²² European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.
²³ European Reference Network RARE-LIVER, Hamburg, Germany; Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
²⁴ European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
²⁵ European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands. Electronic address: [email protected].

PMID: 38878785
DOI: 10.1016/S2468-1253(24)00094-3

Abstract

Liver cyst infections often necessitate long-term hospital admission and are associated with considerable morbidity and mortality. We conducted a modified Delphi study to reach expert consensus for a clinical decision framework. The expert panel consisted of 24 medical specialists, including 12 hepatologists, from nine countries across Europe, North America, and Asia. The Delphi had three rounds. The first round (response rate 21/24 [88%]) was an online survey with questions constructed from literature review and expert opinion, in which experts were asked about their management preferences and rated possible management strategies for seven clinical scenarios. Experts also rated 14 clinical decision-making items for relevancy and defined treatment outcomes. During the second round (response rate 13/24 [54%]), items that did not reach consensus and newly suggested themes were discussed in an online panel meeting. In the third round (response rate 16/24 [67%]), experts voted on definitions and management strategies using an online survey based on previous answers. Consensus was predefined as a vote threshold of at least 75%. We identified five subclassifications of liver cyst infection according to cyst phenotypes and patient immune status and consensus on episode definitions (new, persistent, and recurrent) and criteria for treatment success or failure was reached. The experts agreed that fever and elevated C-reactive protein are pivotal decision-making items for initiating and evaluating the management of liver cyst infections. Consensus was reached on 26 management statements for patients with liver cyst infections across multiple clinical scenarios, including two treatment algorithms, which were merged into one after comments. We provide a clinical decision framework for physicians managing patients with liver cyst infections. This framework will facilitate uniformity in the management of liver cyst infections and can constitute the basis for the development of future guidelines.

Publication types

Review

MeSH terms

Clinical Decision-Making*
Consensus*
Cysts* / diagnosis
Cysts* / therapy
Delphi Technique*
Humans
Liver Diseases* / diagnosis
Liver Diseases* / therapy