Abstract：
BACKGROUND: Diagnosing infective endocarditis (IE) poses a significant challenge. This study aimed to compare the diagnostic accuracy of the 2015 and 2023 Duke clinical criteria introduced by the European Society of Cardiology (ESC) in a cohort of patients suspected of having IE.
METHODS: Conducted retrospectively at two Swiss University Hospitals between 2014-2023, the study involved patients with suspected IE. Each hospitals\' Endocarditis Team categorized case as either IE or not IE. The performance of each iteration of the Duke-ESC clinical criteria was assessed based on the agreement between definite IE and the diagnoses made by the Endocarditis Team.
RESULTS: Among the 3127 episodes with suspected IE, 1177 (38%) were confirmed to have IE. Using the 2015 Duke-ESC clinical criteria, 707 (23%) episodes were deemed definite IE, with 696 (98%) receiving a final IE diagnosis. With the 2023 Duke-ESC clinical criteria, 855 (27%) episodes were classified as definite IE, of which 813 (95%) were confirmed as IE. The 2015 and 2023 Duke-ESC clinical criteria categorized 1039 (33%) and 1034 (33%) episodes, respectively, as possible IE. Sensitivity for the 2015 Duke-ESC and the 2023 Duke-ESC clinical criteria was calculated at 59% (95% CI: 56-62%), and 69% (66-72%), respectively, with specificity at 99% (99-100%), and 98% (97-98%), respectively.
CONCLUSIONS: The 2023 ESC criteria demonstrated significant improvements in sensitivity compared to the 2015 version, although one-third of episodes were classified as possible IE by both versions.
METHODS: Conducted retrospectively at two Swiss University Hospitals between 2014-2023, the study involved patients with suspected IE. Each hospitals\' Endocarditis Team categorized case as either IE or not IE. The performance of each iteration of the Duke-ESC clinical criteria was assessed based on the agreement between definite IE and the diagnoses made by the Endocarditis Team.
RESULTS: Among the 3127 episodes with suspected IE, 1177 (38%) were confirmed to have IE. Using the 2015 Duke-ESC clinical criteria, 707 (23%) episodes were deemed definite IE, with 696 (98%) receiving a final IE diagnosis. With the 2023 Duke-ESC clinical criteria, 855 (27%) episodes were classified as definite IE, of which 813 (95%) were confirmed as IE. The 2015 and 2023 Duke-ESC clinical criteria categorized 1039 (33%) and 1034 (33%) episodes, respectively, as possible IE. Sensitivity for the 2015 Duke-ESC and the 2023 Duke-ESC clinical criteria was calculated at 59% (95% CI: 56-62%), and 69% (66-72%), respectively, with specificity at 99% (99-100%), and 98% (97-98%), respectively.
CONCLUSIONS: The 2023 ESC criteria demonstrated significant improvements in sensitivity compared to the 2015 version, although one-third of episodes were classified as possible IE by both versions.
摘要：
背景：诊断感染性心内膜炎（IE）是一项重大挑战。这项研究旨在比较欧洲心脏病学会（ESC）在怀疑患有IE的患者队列中引入的2015年和2023年杜克大学临床标准的诊断准确性。
方法：2014-2023年在两家瑞士大学医院进行了回顾性研究，该研究涉及疑似IE患者。各医院心内膜炎小组将病例分类为IE或非IE。根据明确的IE与心内膜炎小组的诊断之间的一致性，评估Duke-ESC临床标准的每次迭代的性能。
结果：在3127例疑似IE发作中，1177（38％）被确认为IE。使用2015年Duke-ESC临床标准，707(23%)次发作被认为是明确的IE，696人(98%)接受了最终的IE诊断。根据2023年Duke-ESC临床标准，855(27%)次发作被归类为明确IE，其中813人(95%)被确认为IE。2015年和2023年Duke-ESC临床标准分为1039例（33%）和1034例（33%）。分别,尽可能的IE。2015年Duke-ESC和2023年Duke-ESC临床标准的敏感性计算为59％（95％CI：56-62％），和69％（66-72％），分别,特异性为99%（99-100%），和98％（97-98％），分别。
结论：与2015年版本相比，2023年ESC标准显示出灵敏度的显着提高，尽管两种版本都将三分之一的情节归类为可能的IE。
方法：2014-2023年在两家瑞士大学医院进行了回顾性研究，该研究涉及疑似IE患者。各医院心内膜炎小组将病例分类为IE或非IE。根据明确的IE与心内膜炎小组的诊断之间的一致性，评估Duke-ESC临床标准的每次迭代的性能。
结果：在3127例疑似IE发作中，1177（38％）被确认为IE。使用2015年Duke-ESC临床标准，707(23%)次发作被认为是明确的IE，696人(98%)接受了最终的IE诊断。根据2023年Duke-ESC临床标准，855(27%)次发作被归类为明确IE，其中813人(95%)被确认为IE。2015年和2023年Duke-ESC临床标准分为1039例（33%）和1034例（33%）。分别,尽可能的IE。2015年Duke-ESC和2023年Duke-ESC临床标准的敏感性计算为59％（95％CI：56-62％），和69％（66-72％），分别,特异性为99%（99-100%），和98％（97-98％），分别。
结论：与2015年版本相比，2023年ESC标准显示出灵敏度的显着提高，尽管两种版本都将三分之一的情节归类为可能的IE。
