Division of Infectious Diseases, Amsterdam University Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
Clin Infect Dis. 2024 Apr 10;78(4):922-929. doi: 10.1093/cid/ciae033.
The 2023 Duke-International Society of Cardiovascular Infectious Diseases (ISCVID) criteria for infective endocarditis (IE) were introduced to improve classification of IE for research and clinical purposes. External validation studies are required.
We studied consecutive patients with suspected IE referred to the IE team of Amsterdam University Medical Center (from October 2016 to March 2021). An international expert panel independently reviewed case summaries and assigned a final diagnosis of "IE" or "not IE," which served as the reference standard, to which the "definite" Duke-ISCVID classifications were compared. We also evaluated accuracy when excluding cardiac surgical and pathologic data ("clinical" criteria). Finally, we compared the 2023 Duke-ISCVID with the 2000 modified Duke criteria and the 2015 and 2023 European Society of Cardiology (ESC) criteria.
A total of 595 consecutive patients with suspected IE were included: 399 (67%) were adjudicated as having IE; 111 (19%) had prosthetic valve IE, and 48 (8%) had a cardiac implantable electronic device IE. The 2023 Duke-ISCVID criteria were more sensitive than either the modified Duke or 2015 ESC criteria (84.2% vs 74.9% and 80%, respectively; P < .001) without significant loss of specificity. The 2023 Duke-ISCVID criteria were similarly sensitive but more specific than the 2023 ESC criteria (94% vs 82%; P < .001). The same pattern was seen for the clinical criteria (excluding surgical/pathologic results). New modifications in the 2023 Duke-ISCVID criteria related to "major microbiological" and "imaging" criteria had the most impact.
The 2023 Duke-ISCVID criteria represent a significant advance in the diagnostic classification of patients with suspected IE.
2023 年杜克-国际心血管感染病学会（ISCVID）感染性心内膜炎（IE）标准旨在改进 IE 的分类，以满足研究和临床目的。需要进行外部验证研究。
我们研究了阿姆斯特丹大学医学中心 IE 团队收治的连续疑似 IE 患者（2016 年 10 月至 2021 年 3 月）。一个国际专家小组独立审查病例摘要，并给出“IE”或“非 IE”的最终诊断，作为参考标准，将“明确”的 Duke-ISCVID 分类与该标准进行比较。我们还评估了排除心脏手术和病理学数据（“临床”标准）时的准确性。最后，我们比较了 2023 年 Duke-ISCVID 与 2000 年改良 Duke 标准以及 2015 年和 2023 年欧洲心脏病学会（ESC）标准。
共纳入 595 例连续疑似 IE 患者：399 例（67%）被判定为 IE；111 例（19%）为人工瓣膜 IE，48 例（8%）为心脏植入式电子设备 IE。2023 年 Duke-ISCVID 标准比改良 Duke 标准或 2015 年 ESC 标准更敏感（84.2%比 74.9%和 80%，均 P<0.001），特异性无显著下降。2023 年 Duke-ISCVID 标准与 2023 年 ESC 标准的敏感性相同，但特异性更高（94%比 82%，P<0.001）。临床标准（排除手术/病理学结果）也存在相同的模式。2023 年 Duke-ISCVID 标准中与“主要微生物学”和“影像学”标准相关的新修改具有最大影响。
2023 年 Duke-ISCVID 标准代表了疑似 IE 患者诊断分类的重大进展。
