改良的杜克标准在疑似感染性心内膜炎诊断中的价值——PRO-ENDOCARDITIS 研究。

Diagnostic value of the modified Duke criteria in suspected infective endocarditis -The PRO-ENDOCARDITIS study.

机构信息

Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

出版信息

Int J Infect Dis. 2021 Mar;104:556-561. doi: 10.1016/j.ijid.2021.01.046. Epub 2021 Jan 27.

DOI:10.1016/j.ijid.2021.01.046

PMID:33508475

Abstract

OBJECTIVES

To determine whether relevant comorbidities stratify patients with and without IE and whether these may improve the diagnostic accuracy, in addition to the modified Duke criteria.

METHODS AND RESULTS

261 consecutive patients (aged 60.1 ± 16.1 years, 62.8% male) with suspected IE were prospectively included in this single-center observational trial. Modified Duke criteria and relevant comorbidities as well as clinical characteristics, were assessed. Forty-seven patients had IE, as confirmed by a clinical event committee. Patients with IE had a higher frequency of positive blood cultures (70.2% vs. 36.9%, p < 0.0001), embolic diseases (36.2% vs. 10.8%, p < 0.0001), heart murmurs (27.7% vs. 11.7%, p = 0.01), and intensive care therapy (74.5% vs. 58.4%, p = 0.04). In receiver operating characteristics, the combination of modified Duke criteria without transesophageal echocardiography led to an area under the curve of 0.783 (0.715-0.851). The predictive value was only marginally improved by the addition of heart murmur and intensive care therapy (0.794 [0.724-0.863]). In contrast, transesophageal echocardiography alone achieved an area under the curve of 0.956 (0.937-0.977) and was further improved when adding modified Duke criteria, heart murmur, and intensive care therapy (0.999 [0.998-1.000]).

CONCLUSION

Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography.

TRIAL REGISTRATION

NCT03365193.

摘要

目的

确定相关合并症是否可分层有和无感染性心内膜炎（IE）的患者，以及这些因素是否除改良的 Duke 标准外还可提高诊断准确性。

方法和结果

本前瞻性、单中心观察性试验共纳入 261 例疑似 IE 的连续患者（年龄 60.1±16.1 岁，62.8%为男性）。评估了改良 Duke 标准和相关合并症以及临床特征。47 例患者经临床事件委员会确诊为 IE。IE 患者阳性血培养（70.2% vs. 36.9%，p<0.0001）、栓塞性疾病（36.2% vs. 10.8%，p<0.0001）、心脏杂音（27.7% vs. 11.7%，p=0.01）和重症监护治疗（74.5% vs. 58.4%，p=0.04）的频率更高。在受试者工作特征曲线中，不联合经食管超声心动图的改良 Duke 标准组合的曲线下面积为 0.783（0.715-0.851）。仅添加心脏杂音和重症监护治疗后，预测值略有改善（0.794 [0.724-0.863]）。相比之下，经食管超声心动图单独的曲线下面积为 0.956（0.937-0.977），当添加改良 Duke 标准、心脏杂音和重症监护治疗时，进一步改善（0.999 [0.998-1.000]）。