Compared Performance of the 2023 Duke–International Society for Cardiovascular Infectious Diseases, 2000 Modified Duke, and 2015 European Society of Cardiology Criteria for the Diagnosis of Infective Endocarditis in a French Multicenter Prospective Cohort
François Goehringer, Benoît Lalloué, Christine Selton‐Suty, François Alla, Élisabeth Botelho-Nevers, Catherine Chirouze, Elodie Curlier, Safwane El Hatimi, Amandine Gagneux‐Brunon, Vincent Le Moing, Pascal Lim, Lionel Piroth, C. Strady, Christophe Tribouilloy, Jean‐Marc Virion, Nelly Agrinier, Xavier Duval, Bruno Hoen, Nelly Agrinier, François Alla, Guillaume Béraud, Élisabeth Botelho-Nevers, David Boutoille, Catherine Chirouze, François Delahaye, Xavier Duval, François Goehringer, Bruno Hoen, Bernard Iung, Vincent Le Moing, Christine Selton Suty, C. Strady, Pierre Tattevin, Corentine Alauzet, Patrick Assayag, Kasra Azarnoush, Mathieu Blot, Yohann Bohbot, Kévin Bouiller, Marielle Buisson, Elodie Curlier, Enrica Dorigo, Michel Duong, Mazen Elfarra, Clémentine Estève, Laura Filippetti, Damien Fournier, Nathalie Grand, R. Huguet, Emila Ilic-Habensus, Audrey Le Bot, Benjamin Lefèvre, R. Lepeule, Sophie Mahy, Charles Monnin, Basile Mouhat, Franck Noël, Nathalie Pansu, Lucas Pérez, Andranik Petrosyan, Romain Pierrard, Matthieu Revest, Thibault Sixt, Anne Suzat, C Tassigny, Noémie Tissot, Dehbia Aboudaoud, Hassina Bouguerra, Catherine Campagnac, Carole Charles, Giulia Corradi, Sandra Dupuy, Eola Francius, Sandrine Gerset, Sandrine Gohier, Mesut Gun, Maryse André, Véronique Ronat, Tubanur Unal Albayrak, Marie-Line Erpelding, Nadine Juge, Benoît Lalloué, Willy Ngueyon Sime, Marie Sponga, Jean‐Marc Virion
Abstract
BACKGROUND: The 2023 Duke-International Society for Cardiovascular Diseases (ISCVID) criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. Using an open prospective multicenter cohort of patients treated for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 European Society of Cardiology (ESC) criteria. METHODS: Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated with 95% confidence intervals. RESULTS: Of the 1194 patients analyzed (mean age, 66.1 years; 71.2% males), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% (95% confidence interval [CI], 91.6-94.8), 95.0% (95% CI, 93.7-96.4), and 97.6% (95% CI, 96.6-98.6), respectively (P < .001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% (95% CI, 55.2-67.4), 60.5% (95% CI, 54.4-66.6), and 46.0% (95% CI, 39.8-52.2), respectively. In patients without CIED, sensitivity rates were 94.8% (95% CI, 93.2-96.4), 96.5% (95% CI, 95.1-97.8), and 97.7% (95% CI, 96.6-98.8); specificity rates were 59.0% (95% CI, 51.6-66.3), 56.6% (95% CI, 49.3-64.0), and 53.8% (95% CI, 46.3-61.2), respectively. CONCLUSIONS: Overall, the 2023 Duke-ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity compared with older criteria. This decreased specificity was mainly attributable to patients with CIED.