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Fewer Minor Modified Duke Criteria on Admission Are Associated with Worse 90-Day Mortality in Patients with Confirmed
Felix von Sanden1, Kathrin Orlovius2, Stefanie Andreß1
1Department of Internal Medicine II, Cardiology, Angiology, Pneumology, Internal Intensive Care, Sports and Rehabilitation Medicine, Ulm University Medical Center, 89081 Ulm, Germany.
Insights
Fewer minor Modified Duke Criteria (MDC) in infective endocarditis (IE) patients correlate with delayed diagnosis and increased 90-day mortality. Early IE diagnosis is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Infective endocarditis (IE) diagnosis is challenging, impacting patient morbidity and mortality.
- Modified Duke Criteria (MDC) are dichotomously applied, lacking prognostic value assessment.
- The association between the number of positive MDC and patient outcomes is understudied.
Purpose of the Study:
- To investigate if the quantity of positive Modified Duke Criteria (MDC) at initial presentation can predict patient outcomes in infective endocarditis (IE).
- To analyze the correlation between the number of MDC and 90-day mortality in IE patients.
Main Methods:
- Retrospective data analysis of 130 patients with confirmed IE from December 2009 to December 2019.
- Utilized univariable and multivariable logistic regression to assess correlations.
- Examined the relationship between MDC count and 90-day mortality, diagnosis, and antibiotic therapy timing.
Main Results:
- Fewer minor MDC were independently associated with higher 90-day mortality (OR 1.718, p=0.022).
- History of coronary artery disease also correlated with increased 90-day mortality (OR 4.711, p=0.002).
- Fewer minor MDC linked to delayed IE diagnosis (b=2.341, p=0.024) and antibiotic treatment (b=2.953, p=0.007).
Conclusions:
- Early diagnosis of infective endocarditis is critical for favorable outcomes.
- A low number of minor MDC on initial presentation may indicate delayed diagnosis and treatment.
- This delay is associated with worse patient outcomes in IE.
Abstract:
Background/Objectives: Timely diagnosis of infective endocarditis (IE) remains a significant challenge, and IE poses significant morbidity and mortality. Modified Duke criteria (MDC) are used for the clinical evaluation and diagnosis of IE, but their current use is dichotomous. There are no studies that associate the amount of positive MDC with the patient's outcome. This study intends to analyze whether the amount of MDC on initial presentation can be used for prognostic assumptions. Methods: We conducted a retrospective data analysis on patients with confirmed and suspected IE who were treated at the Department of Internal Medicine II at Ulm University Heart Center from December 2009 to December 2019. Univariable and multivariable logistic regression models were used to find correlations between 90-day mortality and the number of MDC. Results: 130 patients with confirmed IE were included in the analysis. Less minor MDC (OR 1.718; 95%-CI 1.096-3.268; p = 0.022) and a history of coronary artery disease (OR 4.711; 95%-CI 1.791-12.393; p = 0.002) were independently associated with higher 90-day mortality in patients with ultimately confirmed IE. Fewer minor MDC on presentation were associated with later diagnosis (b 2.341; 95%-CI 0.312-4.370; p = 0.024) and antibiotic therapy (b 2.953; 95%-CI 0.82-5.084; p = 0.007) for IE. Conclusions: Early diagnosis of IE is essential for favorable outcomes. Fewer minor MDC on initial presentation may lead to delayed diagnosis, antibiosis, and worse outcomes.
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