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 pr...
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doaj-8e15dd733baf497097d14b85b6baeecd2021-03-27T04:26:03ZengElsevierInternational Journal of Infectious Diseases1201-97122021-03-01104556561Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS studyAmir A. Mahabadi0Ihab Mahmoud1Iryna Dykun2Matthias Totzeck3Peter-Michael Rath4Arjang Ruhparwar5Jan Buer6Tienush Rassaf7Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Corresponding author at: Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyObjectives: 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 [0.998–1.000]). Conclusion: Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography. Trial registration: NCT03365193.http://www.sciencedirect.com/science/article/pii/S1201971221000576Infective endocarditisTransesophageal echocardiographyPre-test probabilityDuke criteria |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Amir A. Mahabadi Ihab Mahmoud Iryna Dykun Matthias Totzeck Peter-Michael Rath Arjang Ruhparwar Jan Buer Tienush Rassaf |
spellingShingle |
Amir A. Mahabadi Ihab Mahmoud Iryna Dykun Matthias Totzeck Peter-Michael Rath Arjang Ruhparwar Jan Buer Tienush Rassaf Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study International Journal of Infectious Diseases Infective endocarditis Transesophageal echocardiography Pre-test probability Duke criteria |
author_facet |
Amir A. Mahabadi Ihab Mahmoud Iryna Dykun Matthias Totzeck Peter-Michael Rath Arjang Ruhparwar Jan Buer Tienush Rassaf |
author_sort |
Amir A. Mahabadi |
title |
Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study |
title_short |
Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study |
title_full |
Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study |
title_fullStr |
Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study |
title_full_unstemmed |
Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study |
title_sort |
diagnostic value of the modified duke criteria in suspected infective endocarditis —the pro-endocarditis study |
publisher |
Elsevier |
series |
International Journal of Infectious Diseases |
issn |
1201-9712 |
publishDate |
2021-03-01 |
description |
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 [0.998–1.000]). Conclusion: Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography. Trial registration: NCT03365193. |
topic |
Infective endocarditis Transesophageal echocardiography Pre-test probability Duke criteria |
url |
http://www.sciencedirect.com/science/article/pii/S1201971221000576 |
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