2023 年杜克-国际心血管感染疾病学会、2000 年改良杜克和 2015 年欧洲心脏病学会感染性心内膜炎诊断标准在法国多中心前瞻性队列中的比较性能。

Compared Performance of the 2023 Duke-International Society for Cardiovascular Infectious Diseases, 2000 Modified Duke, and 2015 European Society of Cardiology Criteria for the Diagnosis of Infective Endocarditis in a French Multicenter Prospective Cohort.

机构信息

Service de maladies infectieuses et tropicales, CHRU de Nancy, Nancy, France.

CHRU de Nancy, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, Nancy, France.

出版信息

Clin Infect Dis. 2024 Apr 10;78(4):937-948. doi: 10.1093/cid/ciae035.

DOI:10.1093/cid/ciae035

PMID:38330171

Abstract

BACKGROUND

The 2023 Duke-International Society for Cardiovascular Diseases (ISCVID) criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. Using an open prospective multicenter cohort of patients treated for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 European Society of Cardiology (ESC) criteria.

METHODS

Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated with 95% confidence intervals.

RESULTS

Of the 1194 patients analyzed (mean age, 66.1 years; 71.2% males), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% (95% confidence interval [CI], 91.6-94.8), 95.0% (95% CI, 93.7-96.4), and 97.6% (95% CI, 96.6-98.6), respectively (P < .001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% (95% CI, 55.2-67.4), 60.5% (95% CI, 54.4-66.6), and 46.0% (95% CI, 39.8-52.2), respectively. In patients without CIED, sensitivity rates were 94.8% (95% CI, 93.2-96.4), 96.5% (95% CI, 95.1-97.8), and 97.7% (95% CI, 96.6-98.8); specificity rates were 59.0% (95% CI, 51.6-66.3), 56.6% (95% CI, 49.3-64.0), and 53.8% (95% CI, 46.3-61.2), respectively.

CONCLUSIONS

Overall, the 2023 Duke-ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity compared with older criteria. This decreased specificity was mainly attributable to patients with CIED.

摘要

背景

2023 年杜克-国际心血管疾病学会（ISCVID）感染性心内膜炎（IE）标准作为 IE 的更新诊断分类被提出。我们使用一个针对 IE 进行治疗的开放前瞻性多中心患者队列，比较了这些新标准与 2000 年改良 Duke 和 2015 年欧洲心脏病学会（ESC）标准的表现。

方法

对 2017 年 1 月至 2022 年 10 月间治疗的 IE 患者的病例进行裁决，判断为明确 IE 或非 IE。每个病例在每个分类中也分为明确或可能/拒绝。用 95%置信区间估计敏感性、特异性和准确性。

结果

在分析的 1194 例患者中（平均年龄 66.1 岁，71.2%为男性），414 例（34.7%）患有人工瓣膜，284 例（23.8%）患有心脏植入式电子设备（CIED）；946 例（79.2%）被裁决为明确 IE；在 2000 年改良 Duke、2015 年 ESC 和 2023 年 Duke-ISCVID 标准中，978 例（81.9%）、997 例（83.5%）和 1057 例（88.5%）被分类为明确 IE。每个标准组的敏感性分别为 93.2%（95%可信区间[CI]，91.6-94.8）、95.0%（95%CI，93.7-96.4）和 97.6%（95%CI，96.6-98.6）（所有 2×2 比较均 P<0.001）。相应的特异性率分别为 61.3%（95%CI，55.2-67.4）、60.5%（95%CI，54.4-66.6）和 46.0%（95%CI，39.8-52.2）。在无 CIED 的患者中，敏感性率分别为 94.8%（95%CI，93.2-96.4）、96.5%（95%CI，95.1-97.8）和 97.7%（95%CI，96.6-98.8）；特异性率分别为 59.0%（95%CI，51.6-66.3）、56.6%（95%CI，49.3-64.0）和 53.8%（95%CI，46.3-61.2）。