title: Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors.
abstract: OBJECTIVE
  The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients.
  
  
  METHODS
  We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots.
  
  
  RESULTS
  171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes.
  
  
  CONCLUSIONS
  Despite FN's clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain. alberto.carmonabayonas@gmail.com.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-4592-3813
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Jiménez-Fonseca
authors.affiliation: Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Virizuela
authors.affiliation: ICO Duran i Reynals, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Antonio
authors.affiliation: Hospital Universitario Clínic, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Font
authors.affiliation: Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Biosca
authors.affiliation: Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ramchandani
authors.affiliation: Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Martinez-Garcia
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Hernando
authors.affiliation: Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Espinosa
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: E M
authors.initials: EM
authors.lastname: de Castro
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Ghanem
authors.affiliation: Hospital Nisa Sevilla Aljarafe, Hospital Universitario Clínico San Carlos, Sevilla, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Beato
authors.affiliation: Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Blasco
authors.affiliation: Universidad Católica Pontificia de Chile, Santiago de Chile, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Garrido
authors.affiliation: Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Mondéjar
authors.affiliation: Consorci Sanitari de Terrassa, Barcelona, Spain.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Arcusa
authors.affiliation: Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Aragón
authors.affiliation: Hospital Clínico Universitario San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Manzano
authors.affiliation: Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Sevillano
authors.affiliation: Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Castañón
authors.affiliation: Hospital Universitario Morales Messeguer, Murcia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ayala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064147:Febrile Neutropenia / Q000209:etiology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: CISNE score; Cancer; Febrile neutropenia; Index; Infection; Risk of complications