A web-based delphi study for eliciting helpful criteria in the positive diagnosis of hemophagocytic syndrome in adult patients.
A web-based delphi study for eliciting helpful criteria in the positive diagnosis of hemophagocytic syndrome in adult patients.
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DOI：
10.1371/journal.pone.0094024
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Fardet L
中科院分区：
文献类型：
--
作者：
Hejblum G;Lambotte O;Galicier L;Coppo P;Marzac C;Aumont C;Fardet L
成人反应性噬血细胞综合征的诊断仍然特别困难，因为没有任何临床或实验室表现是特异性的。我们进行了一项研究，以引出哪些特征构成了积极诊断的有用标准。在这个德尔菲研究中，问卷调查的特征和邀请参加调查的专家都是通过书目检索发布的。问卷通过基于网络的应用程序迭代地向专家提出，并反馈在之前的德尔菲回合中观察到的结果。专家们被要求将每个调查的标准标记为以下类别之一：绝对需要，重要，次要兴趣，或在日常实践环境中不可评估。一个积极的共识被先验地定义为至少75%的答案在绝对需要和重要的类别中观察到。问卷调查了26项标准，来自13个国家的24名专家参加了第二轮和最后一轮德尔菲。对以下9个标准达成了积极的共识：单线性细胞减少症、双线性细胞减少症、全血细胞减少症、骨髓抽吸或组织活检中出现噬血细胞现象、高铁蛋白水平、发热、器官肿大、存在易感基础疾病、高乳酸脱氢酶水平。在13项标准上达成了否定的共识，在4项标准上没有达成共识。这项研究是迄今为止第一个制定国际指南的倡议，专门用于反应性噬血细胞综合征的阳性诊断。
The diagnosis of the reactive form of hemophagocytic syndrome in adults remains particularly difficult since none of the clinical or laboratory manifestations are specific. We undertook a study in order to elicit which features constitute helpful criteria for a positive diagnosis. In this Delphi study, the features investigated in the questionnaire and the experts invited to participate in the survey were issued from a bibliographic search. The questionnaire was iteratively proposed to experts via a web-based application with a feedback of the results observed at the preceding Delphi round. Experts were asked to label each investigated criterion in one of the following categories: absolutely required, important, of minor interest, or not assessable in the routine practice environment. A positive consensus was a priori defined as at least 75% answers observed in the categories absolutely required and important. The questionnaire investigated 26 criteria and 24 experts originating from 13 countries participated in the second and final Delphi round. A positive consensus was reached for the nine following criteria: unilineage cytopenia, bicytopenia, pancytopenia, presence of hemophagocytosis pictures on a bone marrow aspirate or on a tissue biopsy, high ferritin level, fever, organomegaly, presence of a predisposing underlying disease, and high level of lactate dehydrogenase. A negative consensus was reached for 13 criteria, and an absence of consensus was observed for 4 criteria. The study constitutes the first initiative to date for defining international guidelines devoted to the positive diagnosis of the reactive form of hemophagocytic syndrome.
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影响因子：
--
作者：
Fardet, Laurence;Coppo, Paul;Lambotte, Olivier
通讯作者：
Lambotte, Olivier
影响因子：
1.8
作者：
Agresti, A;Coull, BA
通讯作者：
Coull, BA
影响因子：
3.5
作者：
Debin, Marion;Souty, Cecile;Falchi, Alessandra
通讯作者：
Falchi, Alessandra
影响因子：
11.8
作者：
Fisman DN
通讯作者：
Fisman DN
影响因子：
5.9
作者：
WONG, KF;CHAN, JKC
通讯作者：
CHAN, JKC