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
Authors: Goehringer Francois , Lalloué Benoit , Selton-Suty Christine , Alla François , Botelho-Nevers Elisabeth , Chirouze Catherine , Curlier Elodie , El Hatimi Safwane , Gagneux-Brunon Amandine , le Moing Vincent , Lim Pascal , Piroth Lionel , Strady Christophe , Tribouilloy Christophe , Virion Jean-Marc , Agrinier Nelly , Duval Xavier , Hoen Bruno ,   the Association pour l'Etude et la Prévention de l'Endocardite Infectieuse—ObservatoireEI Study Group, Agrinier Nelly , Alla François , Béraud Guillaume , Botelho-Nevers Elisabeth , Boutoille David , Chirouze Catherine , Delahaye François , Duval Xavier , Goehringer François , Hoen Bruno , Iung Bernard , Le Moing Vincent , Suty Christine Selton , Strady Christophe , Tattevin Pierre , Alauzet Corentine , Assayag Patrick , Azarnoush Kasra , Blot Mathieu , Bohbot Yohann , Bouiller Kevin , Buisson Marielle , Curlier Elodie , Dorigo Enrica , Duong Michel , Elfarra Mazen , Esteve Clémentine , Filippetti Laura , Fournier Damien , Grand Nathalie , Huguet Raphaëlle , Ilic-Habensus Emila , Le Bot Audrey , Lefèvre Benjamin , Lepeule Raphaël , Mahy Sophie , Monnin Charles , Mouhat Basile , Noël Franck , Pansu Nathalie , Perez Lucas , Petrosyan Andranik , Pierrard Romain , Revest Matthieu , Sixt Thibault , Suzat Anne , Tassigny Charles , Tissot Noémie , Aboudaoud Dehbia , Bouguerra Hassina , Campagnac Catherine , Charles Carole , Corradi Giulia , Dupuy Sandra , Francius Eola , Gerset Sandrine , Gohier Sandrine , Gun Mesut , André Maryse , Ronat Véronique , Albayrak Tubanur Unal , Erpelding Marie-Line , Juge Nadine , Lalloué Benoit , Sime Willy Ngueyon , Sponga Marie , Virion Jean-Marc 
Published: February 2024

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 &lt; .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.