Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 22;14(1):19524.
doi: 10.1038/s41598-024-70196-x.

Evaluating the Duke Criteria for infectious endocarditis in a single-center retrospective study

Sascha d'Almeida  1 , Kathrin Reischmann  2 , Stefanie Andreß  3 , Dominik Felbel  3 , Tilman Stephan  3 , Birgit Hay  4 , Friederike Rohlmann  4 , Dominik Buckert  3 , Wolfgang Rottbauer  3 , Sinisa Markovic  3
Affiliations

Evaluating the Duke Criteria for infectious endocarditis in a single-center retrospective study

Sascha d'Almeida et al. Sci Rep. .

Abstract

The Duke Criteria have shaped the way infectious endocarditis (IE) is diagnosed in the last 30 years. This study aims to evaluate their current validity and importance in the diagnostic of IE. A retrospective cohort study was conducted on 163 consecutive patients who presented at the University Hospital in Ulm (Germany) with clinical suspicion of IE between 2009 and 2019. With patients' medical records we differentiated between definitive endocarditis (DIE), possible endocarditis (PIE) and rejected endocarditis (RIE) and assessed the validity of the Duke Criteria in comparison to the final discharge diagnosis. We then tried to identify new potential parameters as an addition to the current valid Duke Criteria. The validity of the Duke Criteria improves with the length of hospitalization (especially cardiac imaging criterion, RIE 33.3%, PIE 31.6% and DIE 41.9%, p = 0.622 at admission and RIE 53.3%, PIE 68.4%, DIE 92.2%, p < 0.001 at discharge). At admission, overall sensitivity and specificity were respectively 29.5 and 91.2% in the DIE group. At discharge, sensitivity in the DIE group rose to 77.5% and specificity decreased to 79.4%. Of all screened metrics, microhematuria (p = 0.124), leukocyturia, (p = 0.075), younger age (p = 0.042) and the lack of rheumatoid disease (p = 0.011) showed a difference in incidence (p < 0.2) when comparing DIE and RIE group. In multivariate regression only microhematuria qualified as a potential sixth minor criterion at admission. Even with the latest technological breakthroughs our findings suggest that the Duke Criteria continue to hold value in the accurate assessment of IE. Future efforts must shorten the time until diagnosis.

Keywords: Cardiac imaging; Duke criteria; Infective endocarditis; Major criterion; Microhematuria; Minor criterion; Prosthetic heart valve; Rheumatic disease; Vegetations.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Kaplan Maier Survival Analysis of all IE groups within the first 50 days of hospitalization.
Figure 2
Figure 2
Flow chart of our analysis (created with Biorender).
See this image and copyright information in PMC

References

    1. Taylor, J. The 2009 ESC Guidelines for management of infective endocarditis reviewed. Eur. Heart J.30(19), 2185–2186. 10.1093/eurheartj/ehp369 (2009). 10.1093/eurheartj/ehp369 - DOI - PubMed
    1. Keller, K., Hobohm, L., Munzel, T. & Ostad, M. A. Incidence of infective endocarditis before and after the guideline modification regarding a more restrictive use of prophylactic antibiotics therapy in the USA and Europe. Minerva Cardioangiol.67, 200–206 (2019). 10.23736/S0026-4725.19.04870-9 - DOI - PubMed
    1. Jensen, A. D. et al. Temporal changes in the incidence of infective endocarditis in Denmark 1997–2017: A nationwide study. Int. J. Cardiol.326, 145–152 (2021). 10.1016/j.ijcard.2020.10.029 - DOI - PubMed
    1. Lamas, C. C. & Eykyn, S. J. Suggested modifications to the Duke criteria for the clinical diagnosis of native valve and prosthetic valve endocarditis: Analysis of 118 pathologically proven cases. Clin. Infect. Dis.25, 713–719 (1997). 10.1086/513765 - DOI - PubMed
    1. van der Vaart, T. W. et al. Value of diagnosing immunological phenomena in patients with suspected endocarditis. Infection51, 705–713 (2022). 10.1007/s15010-022-01954-0 - DOI - PMC - PubMed

LinkOut - more resources