Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study

Abstract

To determine whether relevant comorbidities stratify patients with and without IE and whether these may improve the diagnostic accuracy, in addition to the modified Duke criteria. Methods and Results: 261 consecutive patients (aged 60.1 AE 16.1 years, 62.8% male) with suspected IE were prospectively included in this single-center observational trial. Modified Duke criteria and relevant comorbidities as well as clinical characteristics, were assessed. Forty-seven patients had IE, as confirmed by a clinical event committee. Patients with IE had a higher frequency of positive blood cultures (70.2% vs. 36.9%, p < 0.0001), embolic diseases (36.2% vs. 10.8%, p < 0.0001), heart murmurs (27.7% vs. 11.7%, p = 0.01), and intensive care therapy (74.5% vs. 58.4%, p = 0.04). In receiver operating characteristics, the combination of modified Duke criteria without transesophageal echocardiography led to an area under the curve of 0.783 (0.715-0.851). The predictive value was only marginally improved by the addition of heart murmur and intensive care therapy (0.794 [0.724-0.863]). In contrast, transesophageal echocardiography alone achieved an area under the curve of 0.956 (0.937-0.977) and was further improved when adding modified Duke criteria, heart murmur, and intensive care therapy (0.999 [0.998-1.000]). Conclusion: Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography. Trial registration: NCT03365193.

Clinical, Microbiological, and Imaging Characteristics of Infective Endocarditis in Latin America: A Systematic Review

“…Moreover, a prior episode of IE was described in 8.8% among one-third of studies, more than in a French nationwide study (5.4%) (Selton-Suty et al, 2012) but similar than in the EURO-ENDO registry (8.8%) (Habib et al, 2019). A positive aspect of the reviewed articles was that most of them based their IE definition on the Duke or modified Duke criteria; the latter provides excellent diagnostic value for IE cases according to the PRO-ENDOCARDITIS study (Mahabadi et al, 2021).…”

Infective Endocarditis in High-Income Countries

“…Clinical investigations recognize other minor signs, such as hematuria in 25% of cases, splenomegaly in 11%, splinter hemorrhages in 8%, Janeway’s lesions in 5%, Roth’s spots in 5%, and conjunctival hemorrhage in 5% of cases. In such cases, clinical manifestations can be more severe and characterized by sepsis, meningitis, unexplained heart failure, septic pulmonary emboli, stroke, acute peripheral arterial occlusion, and renal failure, which may also be presenting manifestations [ 16 , 17 , 18 , 19 , 20 ]. Blood chemistry tests generally report the following changes in patients with IE: elevated inflammatory markers reveal a high erythrocyte sedimentation rate and C-reactive protein level in two-thirds of cases, while leukocytosis and anemia are found in about half of cases [ 1 , 21 , 22 ].…”

Infective Endocarditis With Secondary Headache: A Case Report

“…A certain immune phenomenon, gram-positive bulbous bacterium, was detected in two sets of blood cultures, and microbiological findings, such as high active inflammatory response and PCT positivity, were observed. Therefore, IE was diagnosed since two major and three minor criteria were satisfied [14].…”