Comparison of the 2015 and 2023 Duke-European Society of Cardiology Criteria Among Patients With Suspected Infective Endocarditis

Background Diagnosing infective endocarditis (IE) poses a significant challenge. This study aimed to compare the diagnostic accuracy of the 2015 and 2023 Duke clinical criteria introduced by the European Society of Cardiology (ESC) in a cohort of patients suspected of having IE.Methods Conducted retrospectively at 2 Swiss university hospitals between 2014 and 2023, the study involved patients with suspected IE. Each hospital's endocarditis team categorized cases as either IE or not IE. The performance of each iteration of the Duke-ESC clinical criteria was assessed based on the agreement between definite IE and the diagnoses made by the endocarditis team.Results Among the 3127 episodes of suspected IE, 1177 (38%) were confirmed to have IE. Using the 2015 Duke-ESC criteria, 707 (23%) episodes were deemed definite IE, with 696 (98%) receiving a final IE diagnosis. With the 2023 Duke-ESC criteria, 855 (27%) episodes were classified as definite IE, of which 813 (95%) were confirmed as IE. The 2015 and 2023 Duke-ESC criteria categorized 1039 (33%) and 1034 (33%) episodes, respectively, as possible IE. Sensitivity for the 2015 Duke-ESC and the 2023 Duke-ESC criteria was calculated at 59% (95% confidence interval, 56%-62%), and 69% (66%-72%), respectively, with specificity at 99% (99%-100%), and 98% (97%-98%), respectively.Conclusions The 2023 Duke-ESC criteria demonstrated significant improvements in sensitivity compared to the 2015 version, although one-third of episodes were classified as possible IE by both versions. Among 3127 episodes of suspected infective endocarditis (IE), the 2023 Duke-European Society of Cardiology (ESC) clinical criteria showed higher sensitivity (69%) compared to 2015 Duke-ESC (59%) criteria for IE diagnosis; their specificity was comparable (98% and 99%, respectively).