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Thorac Cardiovasc Surg
DOI: 10.1055/a-2462-8950
Original Cardiovascular

Overall Accuracy of the Modified Duke Criteria—A Systematic Review and Meta-analysis

Tulio Caldonazo   *
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
,
Panagiotis Tasoudis   *
2   Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, United States
,
Torsten Doenst
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
,
Dimitrios Moris
3   Department of Surgery, Duke University Hospitals, Durham, North Carolina, United States
,
Lillian Kang
3   Department of Surgery, Duke University Hospitals, Durham, North Carolina, United States
,
Alexandros Moschovas
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
,
Hristo Kirov 
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
,
Ricardo E. Treml
4   Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany
,
Michel Pompeu Sá
5   Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
6   UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Stefan Hagel   *
7   Institute for Infectious Diseases and Infection Control, Friedrich-Schiller-University Jena, Germany
,
Mahmoud Diab   *
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
8   Department of Cardiac Surgery, Herz- und Kreislaufzentrum, Rotenburg an der Fulda, Germany
› Author Affiliations Funding TC was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Clinician Scientist Program OrganAge funding number 413668513, by the Deutsche Herzstiftung (DHS, German Heart Foundation) funding number S/03/23, and by the Interdisciplinary Center of Clinical Research of the Medical Faculty Jena. MPS receives support from The Thoracic Surgery Foundation (charitable arm of The Society of Thoracic Surgeons, STS) through the TSF Every Heartbeat Matters Global Structural Heart Fellowship Award for the project “Structural Heart/Minimally Invasive Cardiac Surgery.”
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Abstract

Background Rapid and accurate diagnosis of infective endocarditis (IE) allows timely management of this life-threatening disease and improves outcome. The Duke criteria have traditionally been the clinical method for diagnosing IE. These criteria were reformulated at different timepoints. We aimed to evaluate the real accuracy of the modified Duke criteria based on several studies that concluded the diagnosis of IE.

Methods Three databases were assessed. Studies were considered for inclusion if they reported the use of modified Duke criteria as the initial approach and the confirmation of the diagnosis with the gold standard methods. The meta-analysis of diagnostic test accuracy was performed after fitting the hierarchical summary receiver operating characteristic model (HSROC) with bivariate model and displaying the summarized measures of sensitivity and specificity, and positive and negative likelihood ratios.

Results A total of 11 studies were included. Accuracy in the included studies ranged from 62.3 to 92.2%, sensitivity ranged from 58.3 to 84.0%, and specificity ranged from 50.0 to 100%. The combined overall sensitivity and specificity were 85% (95% CI: 0.77–0.90) and 98% (95% CI: 0.89–0.99), respectively. The positive likelihood ratio was 40.2 (95% CI: 7.26–220.74) and the negative likelihood ratio was 0.15 (95% CI: 0.01–0.23).

Conclusion The analysis reveals that the modified Duke criteria have a high positive likelihood ratio, suggesting a robust correlation between a positive test result and the existence of IE, and a very good overall specificity at 98%. The latter aspect holds significant importance in order to prevent unnecessary overtreatment, given the intricacies involved in managing IE.

Keywords

infective endocarditis - modified Duke criteria - diagnostic - epidemiology

Data Availability Statement

The data underlying this article are available in the article and in its online supplementary material.


Authors' Contribution

T.C., P.T., S.H., and M.D. designed the study. D.M., L.K., and A.M. performed the literature review in three different libraries. T.C., H.K., and R.T. selected the studies, assessed them for risk of bias, performed data abstraction, built the tables, and organized the results. P.T. and M.P.S. performed the statistical analyses. T.C., T.D., S.H., and M.D. analyzed the data. T.C., T.D., S.H., and M.D. wrote the manuscript. All authors read and approved the final version of the manuscript. This modality of meta-analysis involves different steps that need to be executed and coordinated collectively.


* These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 01 July 2024

Accepted: 05 November 2024

Article published online:
29 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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