不同版本的杜克标准在诊断心脏内有假体材料患者感染性心内膜炎中的表现
Performance of Different Versions of Duke Criteria in Diagnosing Infective Endocarditis in Patients With Intracardiac Prosthetic Materials.
作者信息
Papadimitriou-Olivgeris Matthaios, Ledergerber Bruno, Epprecht Jana, Siedentop Berit, Monney Pierre, Frank Michelle, Tzimas Georgios, Fourré Nicolas, Zimmermann Virgile, Domenichini Giulia, Niclauss Lars, Kirsch Matthias, Van Hemelrijck Mathias, Dzemali Omer, Guery Benoit, Hasse Barbara
机构信息
Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Infectious Diseases Service, Hospital of Valais and Institut Central des Hôpitaux, Sion, Switzerland.
出版信息
Open Forum Infect Dis. 2025 Aug 19;12(9):ofaf507. doi: 10.1093/ofid/ofaf507. eCollection 2025 Sep.
BACKGROUND
Diagnosing infective endocarditis (IE) is a significant challenge. This study aimed to compare the diagnostic performance of the 2015 and 2023 European Society of Cardiology (ESC) and the 2023 International Society for Cardiovascular Infectious Diseases (ISCVID) Duke clinical criteria in a cohort of patients with suspected IE and intracardiac prosthetic material.
METHODS
This retrospective study was conducted at 2 Swiss University Hospitals (2014-2024). The reference standard was the diagnosis of the Endocarditis Team or expert clinicians. Patients with IE (reference standard) classified as definite IE by the Duke criteria were considered true positives, while those without IE classified as rejected IE were considered true negatives.
RESULTS
Of the 1025 episodes with suspected IE and intracardiac prosthetic material, 537 (61%) had IE. Using the 2015 ESC, 2023 ESC, and 2023 ISCVID clinical criteria, 324 (32%), 367 (36%), and 430 (42%) episodes were classified as definite IE, respectively. The sensitivity for the 2015 Duke-ESC, 2023 Duke-ESC, and 2023 Duke-ISCVID the clinical criteria was calculated to be 56% (95% CI: 52-60%), 61% (57-65%), and 71% (67-74%), respectively, while the specificity 67% (63-71%), 56% (51-61%), and 34% (29-38%), respectively.
CONCLUSIONS
The 2023 ISCVID Duke clinical criteria demonstrated the highest sensitivity for diagnosing IE compared to the 2015 and 2023 ESC Duke criteria in patients with intracardiac prosthetic material. However, this was at the expense of specificity.
背景
诊断感染性心内膜炎（IE）是一项重大挑战。本研究旨在比较2015年和2023年欧洲心脏病学会（ESC）以及2023年国际心血管感染性疾病学会（ISCVID）的杜克临床标准在一组疑似IE且有心内人工材料的患者中的诊断性能。
方法
这项回顾性研究在2家瑞士大学医院进行（2014 - 2024年）。参考标准是心内膜炎团队或专家临床医生的诊断。被杜克标准分类为确诊IE的IE患者（参考标准）被视为真阳性，而未被诊断为IE且被分类为排除IE的患者被视为真阴性。
结果
在1025例疑似IE且有心内人工材料的病例中，537例（61%）患有IE。使用2015年ESC、2023年ESC和2023年ISCVID临床标准，分别有324例（32%）、367例（36%）和430例（42%）病例被分类为确诊IE。2015年杜克 - ESC、2023年杜克 - ESC和2023年杜克 - ISCVID临床标准的敏感性分别计算为56%（95%CI：52 - 60%）、61%（57 - 65%）和71%（67 - 74%），而特异性分别为67%（63 - 71%）、56%（51 - 61%）和34%（29 - 38%）。
结论
与2015年和2023年ESC杜克标准相比，2023年ISCVID杜克临床标准在有心内人工材料的患者中诊断IE的敏感性最高。然而，这是以牺牲特异性为代价的。
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