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
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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DOI：
10.1007/s00520-017-3985-0
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发表时间：
2018-05-01
影响因子：
3.1
通讯作者：
Cooksley, Tim
中科院分区：
文献类型：
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作者：
Ahn, Shin;Rice, Terry W.;Cooksley, Tim
发热性中性粒细胞减少症患者是一个异质性群体，少数患者出现严重的医学并发症。低风险发热性中性粒细胞减少症的门诊治疗已被证明是安全和具有成本效益的。诸如多国癌症支持治疗协会（MASCC）评分和稳定发热性中性粒细胞减少临床指数（CISNE）等评分系统已被开发并验证用于识别低风险患者。我们的目的是比较这两种评分在识别低风险发热性中性粒细胞减少患者中的表现。我们对2015年美国、英国和韩国三家三级癌症急救中心的发热性中性粒细胞减少症患者进行了汇总分析。主要观察指标为严重并发症的发生情况。入住重症监护病房（ICU）和30天死亡率是次要结局。分析各评分的预测性能。571例患者表现为发热性中性粒细胞减少。根据MASCC风险指数，508例（89.1%）被分类为低危性发热性中性粒细胞减少症，而CISNE分类为60例（10.5%）。总体而言，MASCC评分在检测低危患者方面比CISNE评分具有更大的鉴别力（AUC 0.772, 95% CI 0.726-0.819 vs. 0.681, 95% CI 0.626-0.737, p = 0.0024）。MASCC和CISNE评分在预测低危发热性中性粒细胞减少症患者方面具有合理的区别价值。风险评分应与临床判断结合使用，以确定适合中性粒细胞减少热门诊管理的患者。开发更准确的评分，并在前瞻性设置中验证，将有助于促进更多患者在门诊环境中得到管理。
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.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.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).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.