The Overall Accuracy of the Latest Modified Duke Criteria: A Systematic Review and Meta-Analysis

Background: Early diagnosis of infective endocarditis (IE) is crucial to improve patients’ outcomes. However, diagnosis of IE is remains challenging. The previous modified Duke-Li Criteria (mDC) of the year 2000 showed a highly varied sensitivity of 60 to 80% and a specificity of 80%. In addition to echocardiography, the European Society of Cardiology (ESC) guidelines 2015 recommended the use of 18-fluorodeoxyglucose positron emission computed tomography (FDG-PET CT) and cardiac computer tomography (CT) as imaging modalities to improve the diagnostic accuracy of mDC. This systematic literature review and meta-analysis aimed to evaluate the diagnostic accuracy of the latest modified criteria according to the ESC guidelines 2015 (mDC-ESC).

Method: PubMed, Web of Science, and Cochrane library were searched for recent documentation on the diagnostic value of mDC-ESC. The sensitivity, specificity, summary receiver operating characteristic (SROC) curves, and the area under the SROC curve (AUC) were calculated to evaluate diagnostic efficiency. All studies were assessed using the modified quality tool QUADAS-2.

Results: Eleven studies with a total of 977 patients were included. Two studies provided separate analyses for prosthetic and native valve endocarditis and were therefore evaluated as four studies. The cumulative sensitivity was 0.85 (CI: 0.77–0.91) and specificity was 0.98 (CI: 0.89–1.00). The area under the curve was 0.95 (CI: 0.93–0.97). The summary point of the likelihood ratio analysis showed that the mDC-ESC criteria are prone to confirm IE rather than exclude it. The meta-analysis regression showed that the prospective nature of the study and the presence of prosthetic valve endocarditis were significant factors for the heterogeneity among the studies.

Conclusion: This meta-analysis demonstrated that the modified Duke criteria of the ESC guidelines 2015 are highly accurate in diagnosing IE.

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Artikel online veröffentlicht:
28. Januar 2023