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

Abstract

The MASCC risk index is prospectively validated in a Chinese population. It demonstrates a better overall performance than the Talcott model and is equivalent to ANN model.

Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology Clinical Practice Guideline

“…Of eight studies on the MASCC score, five 38,218,221,223,225 reported the proportion of outpatients versus inpatients at FN onset, which ranged from all outpatients 225 to 50% of inpatients. 38 Six studies 218,219,[221][222][223][224][225] admitted all patients and treated the FNEs in the †Burden of febrile neutropenia refers to the general clinical status of the patient as influenced by the febrile neutropenic episode. It should be evaluated on the following scale: no or mild symptoms (score of 5), moderate symptoms (score of 3), and severe symptoms or moribund (score of 0).…”

“…This study did not find any assay to be a statistically significant predictor of outcome and also reported that performance characteristics of the MASCC score were better than for procalcitonin levels, the assay most strongly correlated with MASCC score. Hui et al 223,224 compared MASCC score Ն 21 with the Talcott prediction rules and with an artificial neural network (ANN) model that this group developed. The ANN model performed approximately as well as the MASCC score, and each performed substantially better than Talcott's rules.…”

“…Although overall performance characteristics reported for the MASCC score are as good as or better than published modifications or alternatives (with the possible exceptions of one that classifies anyone with a complex infection as high risk 222 and another developed for patients in Thailand 226 and not validated prospectively), the key variables of interest here are rates of medical complications and mortality among patients classified as low risk. The only prospective study (Data Supplement Table DS-4) 223,224 to directly compare outcomes for those classified as low risk by MASCC score versus Talcott's rules (selected from a single patient group) reported similar rates of mortality (2% v 1.9%) and poor outcomes (23 of 160; 14.4% v 16 of 101; 15.8%) for the two methods. Data pooled from seven studies (Data Supplement Table DS-4) 38,[218][219][220][222][223][224][225] showed that 197 (11%) of 1,771 patients classified as low risk by MASCC score Ն 21 had complications or other unfavorable empiric therapy outcomes, and 29 (1.6%) died before FN resolved.…”

Prognostic factors for mortality with febrile neutropenia in hospitalized patients

“…8,10,16,18 Several studies have shown that MASCC could predict an unfavorable outcomes in febrile neutropenia when combined with other inflammatory markers, such as procalcitonin or CRP, 10, 19 when compared to inflammatory markers alone. 20 MASCC is still currently the best risk stratification tool for febrile neutropenia, 21 but it does not include neutropenic duration, 17 which was an independent risk factor for prolonged LOS in our study.…”

Complementarity of Clinician Judgment and Evidence Based Models in Medical Decision Making: Antecedents, Prospects, and Challenges

“…This helps clinicians to obtain different perspectives on a variety of topical issues affecting their practice by quickly sharing knowledge and effectively using “wisdom of the medical crowds” [85]. The Journal of Orthopaedic Complications and the Orthopaedic Case Bank have also been launched by the Indian Orthopaedic Research Group (IORG) to accept only complications or complicated cases to elicit discussions by the community of orthopaedic surgeons.…”