title: Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia.
abstract: OBJECTIVE
  Infectious complication could be life-threatening in patients with chemotherapy-induced febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) risk-index score is used to predict the complications of these patients, and it has been focused on identifying low-risk patients who may be candidates for outpatient management. In this study, we evaluated procalcitonin (PCT) and the MASCC score in predicting bacteremia and septic shock in patients with FN.
  
  
  METHODS
  From November 2010 to October 2011, 355 patients with FN were prospectively enrolled. Clinical and laboratory findings, including procalcitonin, and the MASCC score were analyzed and correlated with the infectious complications of FN.
  
  
  RESULTS
  Of the 355 patients, 35 (9.9 %) had bacteremia, and 25 (7.0 %) developed septic shock. PCT ≥ 0.5 ng/mL (OR 3.96, 95 % CI 1.51-10.40), platelet count <100 × 10(3)/mm(3) (OR 2.50, 95 % CI 1.10-5.66), and MASCC score <21 (OR 2.45, 95 % CI 1.03-5.85) were independently predictive of bacteremia, and PCT ≥ 1.5 ng/mL (OR 29.78, 95 % CI 9.10-97.39) and MASCC score <21 (OR 9.46, 95 % CI 3.23-27.72) were independent factors of septic shock. In 306 patients with low-risk FN classified by the MASCC score, 52 had PCT ≥ 0.5 ng/mL and 31 had PCT ≥ 1.5 ng/mL. Of the 52 patients with PCT ≥ 0.5 ng/mL, 12 (23.1 %) had bacteremia, and of the 31 patients with PCT ≥ 1.5 ng/mL, 7 (22.6 %) developed septic shock.
  
  
  CONCLUSIONS
  Implicating PCT as a routine use in clinical practice along with the MASCC score could improve risk stratification of patients with FN.
authors.affiliation: Cancer Emergency Room, Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, South Korea. ans1023@gmail.com
authors.forename: Shin
authors.initials: S
authors.lastname: Ahn
authors.forename: Yoon-Seon
authors.initials: YS
authors.lastname: Lee
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lim
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood / Q000139:chemically induced*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D064147:Febrile Neutropenia / Q000097:blood / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide