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


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

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Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Cardiology
Publication Date
October-December 1997


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.


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