# Fewer Minor Modified Duke Criteria on Admission Are Associated with Worse 90-Day Mortality in Patients with Confirmed Infective Endocarditis

## TL;DR

Fewer minor modified Duke criteria at admission are linked to higher 90-day mortality in infective endocarditis patients.

## Contribution

This study is the first to associate the number of modified Duke criteria with patient outcomes in infective endocarditis.

## Key findings

- Fewer minor MDC on admission correlate with higher 90-day mortality in confirmed IE patients.
- Fewer minor MDC are associated with delayed diagnosis and antibiotic therapy.
- History of coronary artery disease is independently linked to higher mortality in IE patients.

## 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.