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

Objectives: 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 ? 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? 1.00 0]). Conclusion: Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography. Trial registration: NCT03365193. ? 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc Objectives: 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 +/- 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- 1.00 0]). Conclusion: Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography. Trial registration: NCT03365193. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).

Automated summary

The study aimed to determine whether relevant comorbidities can improve the diagnostic accuracy of patients with IE. It was found that patients with IE had a higher frequency of positive blood cultures, embolic diseases, heart murmurs, and intensive care therapy.