Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients.
OBJECTIVE
This is a prospective and observational study comparing the efficacy of risk-assessment models in patients with neutropenic fever in a reference treatment center. The meaning of the complex infection was evaluated.


METHODS
Patients were recruited throughout a 9-month period. Inclusion criteria were histologic diagnosis of malignancy, neutropenic febrile secondary to chemotherapy and/or radiotherapy (absolute neutrophil count of <500/microl and axillary temperature > or = 38 degrees C), and > or = 18 years of age.


RESULTS
Fifty-three febrile neutropenic patients were included. Twenty one of them were classified as low risk by the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the MASCC risk-index scores were, respectively 87.9, 85.0, 90.6, 80.9, and 86.8%. None of the low-risk patients died, but four patients classified as low risk by the MASCC model developed serious medical complications during febrile neutropenic episodes. When we subtracted patients with complex infections from the group of patients with the MASCC risk-index score of > or = 21, we got 15 patients that were classified as low risk by a proposed adjustment by complex infection (PACI) model. None of them developed serious medical complications. The sensitivity, specificity, PPV, NPV, and the accuracy of this new model were, respectively, 100, 75.0, 86.8, 100, and 90.6%.


CONCLUSIONS
The MASCC risk-index score had high sensitivity and specificity to predict the absence of complications, but the PACI model was better than MASCC for predicting the absence of complications in this febrile neutropenic patients.
de Souza Viana
Luciano
L
Infectious Disease and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. lsviana1@yahoo.com.br
Serufo
José Carlos
JC
da Costa Rocha
Manoel Otávio
MO
Costa
Renato Nogueira
RN
Duarte
Roberto Carlos
RC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005334:Fever / Q000209:etiology* / Q000503:physiopathology; D006305:Health Status Indicators; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009503:Neutropenia / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents