Infectious Disease · Internal Medicine · 2 h ago
Updated Duke Criteria Increase Sensitivity but Preserve the Possible Endocarditis Gray Zone
A retrospective study at two Swiss university hospitals assessed three versions of the Duke criteria in 3,448 adults evaluated for suspected infective endocarditis. The 2023 criteria improved sensitivity but left roughly three in ten episodes classified as possible endocarditis, with lower specificity than the 2015 criteria.
- Possible endocarditis classifications remained near 29%–33%.
- 2023 criteria had higher sensitivity than the 2015 criteria.
- Specificity was lower with both 2023 criteria versions.
- Study included patients receiving guideline-concordant cardiac imaging.
Researchers retrospectively assessed 3,448 episodes of suspected infective endocarditis at two Swiss university hospitals from 2014 to 2025. All patients had guideline-concordant multimodality cardiac imaging. An Endocarditis Team’s final diagnosis served as the reference standard; cases were classified using the 2015 Duke-ESC, 2023 Duke-ISCVID, and 2023 Duke-ESC clinical criteria. The cohort included 1,302 episodes adjudicated as endocarditis (38%).
The share classified as possible endocarditis remained similar across versions: 29% with the 2015 Duke-ESC criteria, 33% with the 2023 Duke-ISCVID criteria, and 29% with the 2023 Duke-ESC criteria. For definite endocarditis versus possible or rejected cases, sensitivity was 63%, 74%, and 71%, respectively. For definite or possible endocarditis versus rejected cases, specificity was 72%, 59%, and 66%, respectively.
In this cohort, the newer criteria traded higher sensitivity for lower specificity without reducing the diagnostic gray zone. The retrospective design and use of an Endocarditis Team’s final diagnosis as the reference standard should be considered when interpreting the results; the study does not establish that one criteria version improves patient outcomes.
In practice
For adults evaluated for suspected infective endocarditis who receive guideline-concordant cardiac imaging, these data indicate that the 2023 Duke criteria versions classify more cases as definite than the 2015 version, but at the cost of lower specificity. The proportion labelled possible remained substantial across all versions. This may help clinicians interpret the trade-off between sensitivity and specificity when applying criteria, but the retrospective study does not show that a particular version improves outcomes or resolves uncertainty in individual cases.
AI-generated clinical interpretation · Not editor-reviewed
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Clinical Infectious Diseases: Performance of the recent Duke criteria versions in patients with suspected infective endocarditis and sufficient cardiac imaging: The more things change, the more they remain the same ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.