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Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents

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Abstract

Purpose

Patients with febrile neutropenia are a heterogeneous group with a minority developing serious medical complications. Outpatient management of low-risk febrile neutropenia has been shown to be safe and cost-effective. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score and Clinical Index of Stable Febrile Neutropenia (CISNE), have been developed and validated to identify low-risk patients. We aimed to compare the performance of these two scores in identifying low-risk febrile neutropenic patients.

Methods

We performed a pooled analysis of patients presenting with febrile neutropenia to three tertiary cancer emergency centers in the USA, UK, and South Korea in 2015. The primary outcome measures were the occurrence of serious complications. Admission to an intensive care unit (ICU) and 30-day mortality were secondary outcomes. The predictive performance of each score was analyzed.

Results

Five hundred seventy-one patients presented with febrile neutropenia. With MASCC risk index, 508 (89.1%) were classified as low-risk febrile neutropenia, compared to 60 (10.5%) with CISNE classification. Overall, the MASCC score had a greater discriminatory power in the detection of low-risk patients than the CISNE score (AUC 0.772, 95% CI 0.726–0.819 vs. 0.681, 95% CI 0.626–0.737, p = 0.0024).

Conclusion

Both MASCC and CISNE scores have reasonable discriminatory value in predicting patients with low-risk febrile neutropenia. Risk scores should be used in conjunction with clinical judgment for the identification of patients suitable for outpatient management of neutropenic fever. Developing more accurate scores, validated in prospective settings, will be useful in facilitating more patients being managed in an outpatient setting.

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Authors and Affiliations

  1. Department of Emergency Medicine, Cancer Emergency Room, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Shin Ahn

  2. Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Terry W. Rice & Sai-ching J. Yeung

  3. Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, M20 4BX, UK

    Tim Cooksley

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  1. Shin Ahn
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  4. Tim Cooksley
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Correspondence to Tim Cooksley.

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Ahn, S., Rice, T.W., Yeung, Sc.J. et al. Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Support Care Cancer 26, 1465–1470 (2018). https://doi.org/10.1007/s00520-017-3985-0

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