Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients

Abstract

The purpose of this study was to determine if the Multinational Association for Supportive Care in Cancer (MASCC) risk-index score is able to predict the outcome of febrile neutropenia in patients with underlying hematological malignancy and to look at the other possible predictors of outcome. A retrospective study of 116 episodes of febrile neutropenia in patients who were admitted to the hematology ward of a local medical center in Malaysia between January 1st 2004 and January 31st 2005. Patient characteristics and the MASCC score were compared with outcome. The MASCC score predicted the outcome of febrile neutropenic episodes with a positive predictive value of 82.9%, a sensitivity of 93%, and specificity of 67%. Other predictors of a favorable outcome were those patients who had lymphomas versus leukemias, duration of neutropenia of less than 7 days, low burden of illness characterized by the absence of an infective focus and absence of lower respiratory tract infection, a serum albumin of >25 g/l, and the absence of gram-negative bacteremia on univariate analysis but only serum albumin level, low burden of illness, and presence of respiratory infection were significantly associated with unfavorable outcome after multivariate analysis. The MASCC score is a useful predictor of outcome in patients with febrile neutropenia with underlying hematological malignancies. This scoring system may be adapted for use in local settings to guide the clinical management of patients with this condition.

Prediction of outcome in cancer patients with febrile neutropenia: a prospective validation of the Multinational Association for Supportive Care in Cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network

“…This PPV was 87% in a recent prospective validation study of 663 patients in a multicentric, multinational setting [22], and were reported between 82.9% and 98.3% in other studies [2,6,12,31]. We postulated that the estimated PPV would be around 85% in our local population.…”

“…To determine the optimal number of input variables for the ANN model, we have built four ANN models with the following input parameters: (1) to include all 34 clinical and laboratory parameters, (2) to only include the seven parameters from the MASCC score, (3) to include the 11 parameters significantly associated with outcome identified from univariate logistic regression in the training set, and (4) to include 14 parameters by combining the seven parameters in the MASCC score and the 11 parameters significantly associated with outcome from univariate logistic regression. The area under the ROC curve of these four ANN models was 0.710, 0.693, 0.736, and 0.737 respectively.…”

“…Patients with a score of ≥21 are regarded as low risk and patients with a score of <21 as high risk [19]. The MASCC risk index has since been evaluated in several independent patient populations [2,6,12,22,31]. However, in most of the published studies to date, the sample size is not usually justified, and precision of estimate is not assessed.…”

Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia

“…A small prospective study of 80 FN episodes found that MASCC risk-index score successfully identified 98.3% of low-risk patients and 86.4% of high-risk patients, with a sensitivity and specific- ity of 95% each [14]. Another study of patients with hematologic malignancies showed that MASCC risk-index score identified low-risk and high-risk patients, with positive predictive values of 83% and 85%, respectively [16]. However, considering the proportion of the cancer types, our study comprises a small proportion of hematologic malignancies, and this might have underrepresented the high-risk populations.…”

Bloodstream infections in neutropenic cancer patients: A practical update

“…124 The predictive positive value ranges from 83% to 98%, even though only a small proportion of hematologic patients were included in validation studies. 125,126 The Clinical Index of Stable Febrile Neutropenia (CISNE) score has also been recently proposed for severity evaluation in neutropenic patients with solid tumors and it showed better sensitivity and specificity in this setting when compared to MASCC score. 127 The elements evaluated for risk assessment according to the aforementioned scores are reported in Table 3.…”