2023 年杜克-国际心血管感染性疾病学会感染性心内膜炎分类的特异性评估。

Evaluation of the Specificity of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Classification for Infective Endocarditis.

机构信息

Infectious Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France.

Paris Cité University, Paris, France.

出版信息

Clin Infect Dis. 2024 Apr 10;78(4):930-936. doi: 10.1093/cid/ciae034.

DOI:10.1093/cid/ciae034

PMID:38330172

Abstract

BACKGROUND

The 2023 Duke-ISCVID (International Society of Cardiovascular Infectious Diseases) classification is a new diagnostic tool for infective endocarditis, updating the 2000 modified Duke and the 2015 European Society for Cardiology (ESC) classifications. In comparison, its sensitivity is higher; however, its specificity remains to be evaluated and compared to that of the 2 other classifications in endocarditis suspected patients.

METHODS

We retrospectively collected the characteristics of patients hospitalized in Bichat University's Hospital, Paris, in 2021, who had been evaluated for clinical suspicion of endocarditis, have had at least a transthoracic echocardiography, 2 pairs of blood cultures, 3-month follow-up and in whom endocarditis diagnosis was finally rejected. All patients were classified by 2000 modified Duke, 2015 ESC and 2023 Duke-ISCVID, as though the endocarditis diagnosis had not been rejected.

RESULTS

In total, 130 patients' charts were analyzed. Mean age was 62 years, 84 (64.6%) were male, 39 (30.0%) had prosthetic cardiac valve or valve repair, 21 (16.2%) cardiac implanted electronic device, and 30 (23.1%) other cardiac conditions. Overall, 5, 2, and 5 patients were falsely classified as definite endocarditis with the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID classifications, respectively. The corresponding specificities were 96.2% (95% confidence interval [CI] [90.8%, 98.6%]), 98.5% (95% CI [93.9%, 99.7%]), and 96.2% (95% CI [90.8%, 98.6%]). The rates of possible endocarditis were of 38%, 35%, and 35% in the 3 classifications, respectively.

CONCLUSIONS

The 2023 Duke-ISCVID classification is highly specific for ruling out the diagnosis of definite infective endocarditis in patients who had been evaluated for IE.

摘要

背景

2023 年杜克-ISCVID（国际心血管感染性疾病学会）分类是一种新的感染性心内膜炎诊断工具，对 2000 年改良的杜克和 2015 年欧洲心脏病学会（ESC）分类进行了更新。与后者相比，前者的敏感性更高；然而，其特异性仍有待评估，并与感染性心内膜炎疑似患者中的另外两种分类进行比较。

方法

我们回顾性收集了 2021 年在巴黎比沙医院住院的疑似感染性心内膜炎患者的特征，这些患者至少进行了一次经胸超声心动图检查、2 对血培养、3 个月随访，最终排除了感染性心内膜炎的诊断。所有患者均按照 2000 年改良的杜克、2015 年 ESC 和 2023 年杜克-ISCVID 分类进行分类，尽管最终排除了感染性心内膜炎的诊断。

结果

共分析了 130 例患者的病历。平均年龄为 62 岁，84 例（64.6%）为男性，39 例（30.0%）有心脏假体瓣膜或瓣膜修复，21 例（16.2%）有心脏植入式电子设备，30 例（23.1%）有其他心脏疾病。总的来说，5 例、2 例和 5 例患者在 2000 年改良的杜克、2015 年 ESC 和 2023 年杜克-ISCVID 分类中被错误地归类为明确的心内膜炎。相应的特异性分别为 96.2%（95%置信区间[CI] [90.8%，98.6%]）、98.5%（95% CI [93.9%，99.7%]）和 96.2%（95% CI [90.8%，98.6%]）。在这 3 种分类中，可能的心内膜炎的发生率分别为 38%、35%和 35%。