DIAGNOSIS OF INFECTIVE ENDOCARDITIS - SENSITIVITY OF THE DUKE VS VON-REYN CRITERIA

Background: Because of the highly variable clinical manifestations of infective endocarditis (IE), different sets of diagnostic criteria has te been used to standardize case definitions of IE. We evaluated the v alidity of the recently proposed Duke criteria, as compared with the o lder von Reyn criteria, in patients with no history of injecting drug abuse. Methods: A total of 243 consecutive episodes of suspected, IE i n 222 patients treated during the years 1980 through 1995 in a Finnish teaching hospital were retrospectively evaluated for the likelihood o f IE by means of these 2 classification schemes. Results: Of all disea se episodes, 114 were designated as definite IE by the Duke criteria, as compared with 64 episodes so classified by the von Reyn criteria (P < .001; Fisher exact test). Moreover, as many as 115 disease episodes were rejected by the von Reyn criteria, whereas only 37 episodes were rejected by the Duke criteria (P < .001). Of the cases rejected by th e von Reyn criteria, the Duke clinical criteria designated 6 (5%) as d efinite IE and 72 (63%) as possible IE. Among histopathologically veri fied episodes, 46 were designated as definite IE by the Duke clinical criteria, as compared with a diagnosis of probable IE by the von Reyn criteria in 33 episodes (P = .02). Moreover, 26 pathologically proved cases would have been rejected by the von Reyn criteria had surgery no t been performed, as compared with none being rejected by the Duke cri teria (P < .001). Conclusions: Corroborating earlier findings, the hig her sensitivity of the Duke criteria, as compared with the von Reyn cr iteria, was demonstrated in this study. These results confirm the vali dity of the Duke criteria in diagnosing IE in a non-drug-addict patien t population.