Abstract
BACKGROUND: The 2023 Duke-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 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% men), 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% [91.6-94.8], 95.0% [93.7-96.4], and 97.6% [96.6-98.6], respectively (p<.001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% [55.2-67.4), 60.5% [54.4-66.6], and 46.0% [39.8-52.2], respectively. In patients without CIED, sensitivity rates were 94.8% [93.2-96.4], 96.5% [95.1-97.8], and 97.7% [96.6-98.8] and specificity rates were 59.0% [51.6-66.3], 56.6% [49.3-64.0], and 53.8% [46.3-61.2], respectively. CONCLUSION: Overall, the 2023 Duke-ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity, compared to older criteria. This decreased specificity was mainly attributable to patients with CIED.