Avogadri Nils, Ivarsson Alex, Burup Kristensen Charlotte, Ragnarsson Sigurdur, Rasmussen Magnus
Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Department of Cardiology, Skåne University Hospital, Lund, Sweden.
Infect Dis (Lond). 2025 Feb;57(2):150-158. doi: 10.1080/23744235.2024.2402374. Epub 2024 Sep 13.
The Duke criteria for diagnosing infective endocarditis (IE) were recently updated by the International Society for Cardiovascular Infectious Diseases (ISCVID) with the purpose of enhancing diagnostic specificity and sensitivity. This study investigated the performance of the Duke-ISCVID criteria in relation to previous criteria.
This retrospective single centre cohort study included patients referred to the Lund IE Team (LIET) between 2017 and 2022, and compared episodes classified according to the 2000 modified Duke, European Society of Cardiology (ESC) 2015, and 2023 Duke-ISCVID criteria. The LIET's decision to treat episodes as IE served as the reference standard.
The study cohort comprised 661 episodes of potential IE. The LIET classified 498 (75%) episodes as IE. The Duke-ISCVID criteria classified a slightly higher proportion of episodes as definite IE (56.4%) compared to the ESC 2015 criteria (54.9%), and the modified Duke (51.1%). The Duke-ISCVID criteria had higher sensitivity (72.5%) for definite IE compared to ESC 2015 (70.7%, = .57) and modified Duke (66.1%, = .033). The specificities were similar for the Duke-ISCVID criteria (92.6%), compared to ESC 2015 (93.9%, = .83) and the modified Duke criteria (95.0%, = .49). When considering both definite and possible IE positive, specificity for all criteria was low: 32.5% for the Duke-ISCVID criteria, 41.7% for ESC 2015 ( = .086), and 42.3% for modified Duke criteria ( = .11), while the sensitivity was not significantly lower.
The Duke-ISCVID criteria demonstrated slightly improved sensitivity for diagnosing IE whereas specificity remained unchanged. Further refinement of the Duke-ISCVID criteria is needed to balance sensitivity and specificity.
国际心血管感染性疾病学会（ISCVID）最近更新了用于诊断感染性心内膜炎（IE）的杜克标准，目的是提高诊断的特异性和敏感性。本研究调查了杜克-ISCVID标准相对于先前标准的性能。
这项回顾性单中心队列研究纳入了2017年至2022年间转诊至隆德IE团队（LIET）的患者，并比较了根据2000年修订的杜克标准、欧洲心脏病学会（ESC）2015年标准和2023年杜克-ISCVID标准分类的病例。LIET将病例视为IE的决定作为参考标准。
研究队列包括661例潜在IE病例。LIET将498例（75%）病例分类为IE。与ESC 2015年标准（54.9%）和修订后的杜克标准（51.1%）相比，杜克-ISCVID标准将略高比例的病例分类为确诊IE（56.4%）。与ESC 2015年标准（70.7%，P = 0.57）和修订后的杜克标准（66.1%，P = 0.033）相比，杜克-ISCVID标准对确诊IE的敏感性更高（72.5%）。与ESC 2015年标准（93.9%，P = 0.83）和修订后的杜克标准（95.0%，P = 0.49）相比，杜克-ISCVID标准的特异性相似（92.6%）。当同时考虑确诊和可能的IE阳性时，所有标准的特异性都很低：杜克-ISCVID标准为32.5%，ESC 2015年标准为41.7%（P = 0.086），修订后的杜克标准为42.3%（P = 0.11），而敏感性没有显著降低。
杜克-ISCVID标准在诊断IE方面显示出敏感性略有提高，而特异性保持不变。需要进一步完善杜克-ISCVID标准以平衡敏感性和特异性。
