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Should Microhematuria Be Incorporated into the 2023 Duke-International Society for Cardiovascular Infectious Diseases

Jean Regina1, Louis Stavart2, Benoit Guery3

  • 1Department of Internal Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.

Antibiotics (Basel, Switzerland)
|July 29, 2025
PubMed

Insights

Microhematuria is common in infective endocarditis (IE) but does not improve diagnosis. Adding it to the 2023 Duke-ISCVID criteria did not enhance diagnostic performance for IE.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Nephrology

Background:

  • Microhematuria is frequently observed in patients with infective endocarditis (IE).
  • Current diagnostic criteria for IE, such as the 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) guidelines, do not specifically incorporate microhematuria.
  • The diagnostic utility of microhematuria in suspected IE cases requires further investigation.

Purpose of the Study:

  • To evaluate the diagnostic performance of the 2023 Duke-ISCVID minor immunological criteria for infective endocarditis.
  • To assess whether the addition of microhematuria to these criteria can enhance diagnostic accuracy.
  • To identify clinical associations of microhematuria in patients with suspected IE.

Main Methods:

  • Retrospective analysis of 801 patients with suspected IE and urinalysis at Lausanne University Hospital (2014-2024).
  • Microhematuria defined as >5 red blood cells per high power field (HPF).
  • Comparison of diagnostic performance of 2023 ISCVID-Duke criteria with and without the inclusion of microhematuria.

Main Results:

  • Microhematuria was present in 58% of suspected IE cases, with no significant difference between confirmed IE and non-IE groups.
  • Inclusion of microhematuria increased the proportion of patients meeting minor immunological criteria from 5% to 59%.
  • Adding microhematuria improved sensitivity (75% to 86%) but decreased specificity (52% to 40%) of the 2023 ISCVID-Duke criteria.

Conclusions:

  • Microhematuria is a common finding in suspected infective endocarditis but is not specifically associated with the diagnosis.
  • Incorporating microhematuria into the 2023 ISCVID-Duke minor immunological criteria does not improve the overall diagnostic performance.
  • Microhematuria in suspected IE is associated with female sex, enterococcal bacteremia, sepsis, acute kidney injury, and embolic events.
Keywords:
Duke criteriaacute kidney injurybacteremiaembolic eventsinfective endocarditismicrohematuriasepsisurinalysis

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