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Validation of duke criteria in the diagnosis of infective endocarditis among patients admitted at the Philippine Heart Center.

Author

Jaime F. Cayetano Jr Jr.,
Adrian C. Pena,
Leonard Warren S. Rondilla,
Jennifer A. Chua ,
Lao Lam Sun

Related Institution

Publication Information

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Journal of Cardiology
Frequency
Others
Publication Date
October-December 1997
Volume
25
Issue
4
Page(s)
161-166

Abstract

BACKGROUND AND OBJECTIVE. The Duke criteria have been validated in different countries as significantly more effective than the Vohn Reyn criteria in diagnosing infective endocarditis (IE). Confronted with this issue of significance of merit, this study determined the diagnostic sensitivity, specificity and predictive values of Duke clinical criteria using pathologically confirmed cases as gold standard.


METHODS AND RESULTS. Out of the 91 patients suspected to have infected endocarditis who satisfied Duke clinical criteria, 45 patients underwent surgical intervention with pathological confirmation; 40 patients were included in the study. Twenty seven patients were classified in the definite category and 5 were classified as rejected. Sixty-six percent in the definite category has 2 major criteria. Two by two tables were done wherein the possible category was incorporated in the rejected category, the sensitivity and specificity of Duke criteria is 86% and 82%, respectively with a (+) PV of 92, (-) PV of 69. Incorporation of the possible to definite category showed a sensitivity and specificity of 96% and 36% with a (+) PV and a (-) PV of 80%. The likelihood ratio for definite, possible and rejected categories were 4.8, 0.2, 0.08, respectively.


CONCLUSION. Duke criteria for infective endocarditis is sensitive and specific with a high positive and negative predictive value for diagnosing IE. A definite category by Duke is 4.8x more likely to occur in patients with IE with a posttest probability of 90% based on the normogram proposed by Fagan. Modification of the Duke criteria was done to collapse the possible category into the rejected category. With this modification, the diagnostic acumen obtained from the definite Duke clinical criteria was still preserved.

References

1. Von Reyn, , et al, . "Inefective endocarditis based on strict case definitions" Ann Intern Med 94, 505-518, 1981
2. Durack, I.T. , Lukes, A.S. , Bright, D.K. . "The Duke endocarditis; utilization of specific echocardiographic findings" American Journal of Medicine 96, 211-219, 1994
3. Bayer, A.S. , Ward, J.I. , Ginzton, L.E. , et al, . "Evaluation of new clinical criteria for diagnosis of infective endocarditis" The American Journal of Medicine 96, 211-219, 1994
4. Farland, M.M. . "Pathology of infective endocarditis" Second Ed. New york Raven Press , 57-83, 1992
5. Washington, J.A. . "The microbiologic diagnosis of IE" Journal of Antimicrobial Chemotherapy 20(s): 29-39, 1987
6. Bayer, A.S. , Lam, K. , Ginzton, L. , Norman, D.C. , Chiu, C.Y. , Ward, J.L. . "Staphylococcus aureus bacteremia; Clinical serologic echocardiographic findings in patients with and without endocarditis" Arch Intern Med 147, 457-462, 1987
7. Fagan, T.S. . "Normogram for Baye's theorem" New England Journal of Medicine 293, 257, 1975
8. Von Reyn, C.F. , Arbeit, R.D. . "Case definition's for IE" The American Journal of Medicine 96, 220-222, 1994
9. Bayer, A.S. . "Infective endocarditis: State of the art" Clinical Infectious Diseases 17, 313-322, 1993
10. Tarpenning, M.S. , Buggy, B.F. , Kauffman, C.F. . "Infective Endocarditis; Clinical features in young and elderly patients" The American Journal of Medicine 83, 626-634, 1987
11. Arguello, E.A. , Varini, S. , Romorini, A. , et al, . "Infective endocarditis in the Argentine Republic (abst.152) 3rd International Symposium on Modern Concepts in Endocarditis, Boston" , 1995
12. Hoen, B. , Selton-Suty, C. , Danchin, N. , et al, . "Evaluation of the Duke criteria vs Beth Israel cirteria in the diagnosis of IE" Clinical Infectious Diseases 21, 905-909, 1995
13. Kanaous, K. , Antoniados, A. , Venetis, C. , et al, . "Retrospective evaluation of Duke criteria in 60 cases of infective endocarditis (abstr. 138, 3rd International Symposium in Modern concept in Endocarditis, Boston" , 1995
14. Dodds, G.A. III, Sexton, D.J. , Durack, D.T. , et al, . "The Duke Endocarditis Service. Negative Predictive value of Duke criteria for the diagnosis of infective endocarditis" American Journal of Cardiology 77, 403-407, 1996
15. Hoen, B. , Beguinot, I. , Maignana, M. , et al, . "Evaluation of the Duke criteria vs the Beth Israel criteria for the diagnosis of infective endocarditis" Clinical Infectious Diseases 21, 905-909, 1995
16. Martin, R.P. , Miltzer, R.S. , Chia, B.L. , et al, . "Clinical utility of 2D echocardiography in the diagnosis of infective endocarditis " American Journal of Cardiology 46, 379, 1980

Physical Location

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Box No.50 Fulltext Print Format
Philippine Council for Health Research and Development Fulltext pdf (Request Document)

 
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