title: A nomogram for predicting complications in patients with solid tumours and seemingly stable febrile neutropenia.
abstract: BACKGROUND
  We sought to develop and externally validate a nomogram and web-based calculator to individually predict the development of serious complications in seemingly stable adult patients with solid tumours and episodes of febrile neutropenia (FN).
  
  
  METHODS
  The data from the FINITE study (n=1133) and University of Salamanca Hospital (USH) FN registry (n=296) were used to develop and validate this tool. The main eligibility criterion was the presence of apparent clinical stability, defined as events without acute organ dysfunction, abnormal vital signs, or major infections. Discriminatory ability was measured as the concordance index and stratification into risk groups.
  
  
  RESULTS
  The rate of infection-related complications in the FINITE and USH series was 13.4% and 18.6%, respectively. The nomogram used the following covariates: Eastern Cooperative Group (ECOG) Performance Status ⩾2, chronic obstructive pulmonary disease, chronic cardiovascular disease, mucositis of grade ⩾2 (National Cancer Institute Common Toxicity Criteria), monocytes <200/mm(3), and stress-induced hyperglycaemia. The nomogram predictions appeared to be well calibrated in both data sets (Hosmer-Lemeshow test, P>0.1). The concordance index was 0.855 and 0.831 in each series. Risk group stratification revealed a significant distinction in the proportion of complications. With a ⩾116-point cutoff, the nomogram yielded the following prognostic indices in the USH registry validation series: 66% sensitivity, 83% specificity, 3.88 positive likelihood ratio, 48% positive predictive value, and 91% negative predictive value.
  
  
  CONCLUSIONS
  We have developed and externally validated a nomogram and web calculator to predict serious complications that can potentially impact decision-making in patients with seemingly stable FN.
authors.affiliation: Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Paula Jiménez
authors.initials: PJ
authors.lastname: Fonseca
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, Murcia 30008, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Ignacio Matos
authors.initials: IM
authors.lastname: García
authors.affiliation: Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Marcos
authors.affiliation: Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Castañón
authors.affiliation: Medical Oncology Department, ICO Duran i Reynals, Barcelona, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Antonio
authors.affiliation: Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Font
authors.affiliation: Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Biosca
authors.affiliation: Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Blasco
authors.affiliation: Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Lozano
authors.affiliation: Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain.
authors.forename: Avinash
authors.initials: A
authors.lastname: Ramchandani
authors.affiliation: Medical Oncology Department, Hospital NISA Aljarafe, Sevilla, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Beato
authors.affiliation: Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Eva Martínez
authors.initials: EM
authors.lastname: de Castro
authors.affiliation: Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Espinosa
authors.affiliation: Medical Oncology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Martínez-García
authors.affiliation: Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Ismael
authors.initials: I
authors.lastname: Ghanem
authors.affiliation: Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Jorge Hernando
authors.initials: JH
authors.lastname: Cubero
authors.affiliation: Medical Oncology Department, Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: Isabel Aragón
authors.initials: IA
authors.lastname: Manrique
authors.affiliation: Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Francisco García
authors.initials: FG
authors.lastname: Navalón
authors.affiliation: Medical Oncology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Sevillano
authors.affiliation: Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors.forename: Aránzazu
authors.initials: A
authors.lastname: Manzano
authors.affiliation: Medical Oncology Department, Hospital Universitario Virgen de Macarena, Sevilla, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Virizuela
authors.affiliation: Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Garrido
authors.affiliation: Medical Oncology Department, Hospital Universitario de La Princesa, Madrid, Spain.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Mondéjar
authors.affiliation: Medical Oncology Department, Consorci Sanitari de Terrassa, Barcelona, Spain.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Arcusa
authors.affiliation: Intensive Care Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain.
authors.forename: Yaiza
authors.initials: Y
authors.lastname: Bonilla
authors.affiliation: Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Quionia
authors.initials: Q
authors.lastname: Pérez
authors.affiliation: Medical Oncology Department, Complejo Universitario de Pontevedra, Pontevedra, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gallardo
authors.affiliation: Medical Oncology Department, Hospital Virgen de la Luz de Cuenca, Madrid, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Del Carmen Soriano
authors.affiliation: Internal Medicine Department, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Cardona
authors.affiliation: Department of Construction and Manufacturing Engineering, University of Oviedo, Spain.
authors.forename: Fernando Sánchez
authors.initials: FS
authors.lastname: Lasheras
authors.affiliation: Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Cruz
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, Murcia 30008, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ayala
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D064147:Febrile Neutropenia / Q000150:complications*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D007239:Infections / Q000453:epidemiology*; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000453:epidemiology*; D015337:Multicenter Studies as Topic; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D049451:Nomograms; D011237:Predictive Value of Tests; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity