评估 HANDOC 评分与 2023 年国际心血管感染病学会和欧洲心脏病学会杜克临床标准在链球菌菌血症患者中诊断感染性心内膜炎的应用。
Evaluation of the HANDOC Score and the 2023 International Society of Cardiovascular Infectious Diseases and European Society of Cardiology Duke Clinical Criteria for the Diagnosis of Infective Endocarditis Among Patients With Streptococcal Bacteremia.
机构信息
Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Infection Prevention and Control Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
出版信息
Clin Infect Dis. 2024 Aug 16;79(2):434-442. doi: 10.1093/cid/ciae315.
BACKGROUND
Streptococci are a common cause of infective endocarditis (IE). We aimed to evaluate the performance of the HANDOC score to identify patients at high risk for IE and the Duke clinical criteria of the European Society of Cardiology (ESC; 2015 and 2023 versions) and the 2023 version from the International Society of Cardiovascular Infectious Diseases (ISCVID) in diagnosing IE among patients with streptococcal bacteremia.
METHODS
This retrospective study included adult patients with streptococcal bacteremia hospitalized at Lausanne University Hospital. Episodes were classified as IE by the Endocarditis Team. A HANDOC score >2 classified patients as high risk for IE.
RESULTS
Among 851 episodes with streptococcal bacteremia, IE was diagnosed in 171 episodes (20%). Among 607 episodes with non-β-hemolytic streptococci, 213 (35%) had HANDOC scores >2 points; 132 (22%) had IE. The sensitivity of the HANDOC score to identify episodes at high risk for IE was 95% (95% confidence interval [CI], 90%-98%), the specificity 82% (95% CI, 78%-85%), and the negative predictive value (NPV) 98% (95% CI, 96%-99%). 2015 Duke-ESC, 2023 Duke-ISCVID, and 2023 Duke-ESC clinical criteria classified 114 (13%), 145 (17%), and 126 (15%) episodes as definite IE, respectively. Sensitivity (95% CI) for the 2015 Duke-ESC, 2023 Duke-ISCVID, and 2023 Duke-ESC clinical criteria was calculated at 65% (57%-72%), 81% (74%-86%), and 73% (65%-79%), respectively, with specificity (95% CI) at 100% (98%-100%), 99% (98%-100%), and 99% (98%-100%), respectively.
CONCLUSIONS
The HANDOC score showed an excellent NPV to identify episodes at high risk for IE. Among the different versions of the Duke criteria, the 2023 Duke-ISCVID version fared better for the diagnosis of IE among streptococcal bacteremia.
背景
链球菌是感染性心内膜炎（IE）的常见病因。我们旨在评估 HANDOC 评分识别 IE 高危患者的表现，以及欧洲心脏病学会（ESC；2015 年和 2023 年版）和 2023 年国际心血管感染疾病学会（ISCVID）的 Duke 临床标准，用于诊断链球菌血症患者的 IE。
方法
本回顾性研究纳入了在洛桑大学医院住院的链球菌血症成年患者。心内膜炎团队对发作进行分类。HANDOC 评分>2 分将患者归类为 IE 高危。
结果
在 851 例链球菌血症发作中，171 例（20%）诊断为 IE。在 607 例非β-溶血性链球菌血症中，213 例（35%）HANDOC 评分>2 分；132 例（22%）IE。HANDOC 评分识别 IE 高危发作的敏感性为 95%（95%置信区间[CI]，90%-98%），特异性为 82%（95%CI，78%-85%），阴性预测值（NPV）为 98%（95%CI，96%-99%）。2015 年 Duke-ESC、2023 年 Duke-ISCVID 和 2023 年 Duke-ESC 临床标准分别将 114 例（13%）、145 例（17%）和 126 例（15%）定为明确 IE。2015 年 Duke-ESC、2023 年 Duke-ISCVID 和 2023 年 Duke-ESC 临床标准的敏感性（95%CI）分别为 65%（57%-72%）、81%（74%-86%）和 73%（65%-79%），特异性（95%CI）分别为 100%（98%-100%）、99%（98%-100%）和 99%（98%-100%）。
结论
HANDOC 评分对识别 IE 高危发作具有极好的 NPV。在不同版本的 Duke 标准中，2023 年 Duke-ISCVID 版本在诊断链球菌血症患者的 IE 方面表现更好。
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