Department of Medicine II, Ulm University Medical Center, Ulm, Germany.
Department of Anesthesiology and Intensive Care, Ulm University Medical Center, Ulm, Germany.
Sci Rep. 2024 Aug 22;14(1):19524. doi: 10.1038/s41598-024-70196-x.
The Duke Criteria have shaped the way infectious endocarditis (IE) is diagnosed in the last 30 years. This study aims to evaluate their current validity and importance in the diagnostic of IE. A retrospective cohort study was conducted on 163 consecutive patients who presented at the University Hospital in Ulm (Germany) with clinical suspicion of IE between 2009 and 2019. With patients' medical records we differentiated between definitive endocarditis (DIE), possible endocarditis (PIE) and rejected endocarditis (RIE) and assessed the validity of the Duke Criteria in comparison to the final discharge diagnosis. We then tried to identify new potential parameters as an addition to the current valid Duke Criteria. The validity of the Duke Criteria improves with the length of hospitalization (especially cardiac imaging criterion, RIE 33.3%, PIE 31.6% and DIE 41.9%, p = 0.622 at admission and RIE 53.3%, PIE 68.4%, DIE 92.2%, p < 0.001 at discharge). At admission, overall sensitivity and specificity were respectively 29.5 and 91.2% in the DIE group. At discharge, sensitivity in the DIE group rose to 77.5% and specificity decreased to 79.4%. Of all screened metrics, microhematuria (p = 0.124), leukocyturia, (p = 0.075), younger age (p = 0.042) and the lack of rheumatoid disease (p = 0.011) showed a difference in incidence (p < 0.2) when comparing DIE and RIE group. In multivariate regression only microhematuria qualified as a potential sixth minor criterion at admission. Even with the latest technological breakthroughs our findings suggest that the Duke Criteria continue to hold value in the accurate assessment of IE. Future efforts must shorten the time until diagnosis.
杜克标准在过去 30 年中塑造了感染性心内膜炎（IE）的诊断方式。本研究旨在评估其在 IE 诊断中的当前有效性和重要性。对 2009 年至 2019 年期间在德国乌尔姆大学医院就诊的 163 例疑似 IE 的连续患者进行了回顾性队列研究。通过患者的病历记录，我们将明确的心内膜炎（DIE）、可能的心内膜炎（PIE）和排除的心内膜炎（RIE）区分开来，并将杜克标准与最终出院诊断进行比较，以评估其有效性。然后，我们试图确定新的潜在参数，作为当前有效杜克标准的补充。随着住院时间的延长，杜克标准的有效性提高（特别是心脏影像学标准，入院时 RIE 为 33.3%，PIE 为 31.6%，DIE 为 41.9%，p=0.622，出院时 RIE 为 53.3%，PIE 为 68.4%，DIE 为 92.2%，p<0.001）。入院时，DIE 组的总敏感性和特异性分别为 29.5%和 91.2%。出院时，DIE 组的敏感性上升至 77.5%，特异性下降至 79.4%。在所有筛选的指标中，镜下血尿（p=0.124）、白细胞尿、（p=0.075）、年龄较小（p=0.042）和无类风湿病（p=0.011）在 DIE 和 RIE 组比较时，发病率存在差异（p<0.2）。多变量回归分析仅显示镜下血尿在入院时可作为潜在的第六个次要标准。即使有了最新的技术突破，我们的研究结果表明，杜克标准在 IE 的准确评估中仍然具有价值。未来的研究必须缩短诊断所需的时间。
