EGPAware: a European Delphi consensus study on red flags for suspicion of eosinophilic granulomatosis with polyangiitis

Objectives: Diagnosing eosinophilic granulomatosis with polyangiitis (EGPA) is challenging due to its rarity, multisystem involvement, and varied clinical presentation, often resulting in delayed diagnoses and associated complications. EGPAware project aimed to establish a first European Delphi consensus on red flags for raising suspicion of EGPA to assist the prompt identification, referral, and diagnosis of these patients. Methods: EGPAware was a European Delphi study led by a multidisciplinary committee that developed the survey based on the red flags from a previously published Spanish systematic review and focused on clinical suspicion indicators. Data analysis used descriptive statistics, with consensus defined as ≥70% agreement. Statements with <70% consensus in the first round were revisited again in round 2. In the second round, panellists additionally ranked the 10 most relevant red flags by clinical importance and frequency of observation. Results: A multidisciplinary European group of 53 physicians with expertise in EGPA completed the 2-round Delphi survey. Consensus was reached on 25 red flags. Mononeuritis multiplex, lung infiltrates/nodules, vasculitis on biopsy, and myeloperoxidase-antineutrophil cytoplasmic antibodies positivity were the highest-ranked signs based on clinical relevance, whereas lung infiltrates/nodules, nasal polyposis, and mononeuritis multiplex were most frequently observed in panellists' experience. Conclusions: The EGPAware study provides a useful checklist of consensual red flags to be used in clinical practice to help clinicians identify patients with EGPA early. The study supports a multidisciplinary approach to EGPA diagnosis and management. Further research is recommended to refine diagnostic tools and validate these findings.