Background Since publication of Duke criteria for infective endocarditis (IE) diagnosis, several modifications have been proposed. We aimed to evaluate the diagnostic performance of the Duke-ISCVID 2023 criteria compared to prior versions from 2000 (Duke-Li 2000) and 2015 (Duke-ESC 2015). Methods This study was conducted at two University Hospitals between 2014-2022 among patients with suspected IE. A case was classified as IE (final IE diagnosis) by the Endocarditis Team. Sensitivity for each version of the Duke criteria was calculated among patients with confirmed IE based on pathological, surgical and microbiological data. Specificity for each version of the Duke criteria was calculated among patients with suspected IE for whom IE diagnosis was ruled out. Results In total 2132 episodes with suspected IE were included; of which 1101 (52%) had final IE diagnosis. Definite IE by pathologic criteria was found in 285 (13%), 285 (13%), and 345 (16%) patients using the Duke-Li 2000, Duke-ESC 2015 or the Duke-ISCVID 2023 criteria, respectively. IE was excluded by histopathology in 25 (1%) patients. The Duke-ISCVID 2023 clinical criteria showed a higher sensitivity (84%) compared to previous versions (70%). However, specificity of the new clinical criteria was lower (60%) compared to previous versions (74%). Conclusions The Duke-ISCVID 2023 criteria led to an increase in sensitivity compared to previous versions. Further studies are needed to evaluate items that could increase sensitivity by reducing the number of IE patients misclassified as possible, but without having detrimental effect on specificity of Duke criteria.

中文翻译：

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2023 年 Duke-ISCVID 标准对疑似感染性心内膜炎患者多中心队列的评估

背景 自从杜克大学感染性心内膜炎 (IE) 诊断标准发布以来，已经提出了一些修改。我们的目的是评估 Duke-ISCVID 2023 标准与 2000 年 (Duke-Li 2000) 和 2015 年 (Duke-ESC 2015) 之前版本相比的诊断性能。方法 本研究于 2014 年至 2022 年间在两所大学医院针对疑似 IE 患者进行。心内膜炎小组将一例病例归类为 IE（最终 IE 诊断）。根据病理、手术和微生物学数据，在确诊 IE 的患者中计算每个版本 Duke 标准的敏感性。在排除 IE 诊断的疑似 IE 患者中计算了各个版本 Duke 标准的特异性。结果 共纳入 2132 例疑似 IE 病例；其中 1101 人（52%）最终诊断为 IE。使用 Duke-Li 2000、Duke-ESC 2015 或 Duke-ISCVID 2023 标准，分别在 285 名 (13%)、285 名 (13%) 和 345 名 (16%) 患者中发现根据病理标准确定的 IE。 25 名 (1%) 患者通过组织病理学排除了 IE。与之前版本 (70%) 相比，Duke-ISCVID 2023 临床标准显示出更高的敏感性 (84%)。然而，与之前版本 (74%) 相比，新临床标准的特异性较低 (60%)。结论 与之前的版本相比，Duke-ISCVID 2023 标准的敏感性有所提高。需要进一步的研究来评估可以通过尽可能减少错误分类的 IE 患者数量来提高敏感性的项目，但又不会对 Duke 标准的特异性产生不利影响。