Acil Serviste Düşük Riskli Febril Nötropeni Hastalarını Tanımada Skorlama Sistemleri: MASCC, CISNE ve qSOFA Skorunun Kullanılabilirliği

Abstract

Amaç: Acil servis ortamında qSOFA (quick Sequential Organ Failure Assessment), MASCC (Multinational Association for Supportive Care in Cancer) ve CİSNE (Clinical Index of Stable Febrile Neutropenia) skorlarının düşük riskli febril nötropeni hastalarının belirlemedeki etkinliğini ve kullanılabilirliğini araştırmayı amaçladık. Gereç ve Yöntem: Hastaların risk skorları hesaplanarak kılavuzlara göre düşük riskli ve yüksek riskli kategorilerine ayrıldı. Ciddi komplikasyonlar ve 30 günlük mortalite kaydedildi. Hayatta kalan veya ciddi komplikasyon gelişmeyen hastalar düşük riskli FN olarak tanımlandı. Bulgular: Hastaların ortanca yaşı 63 yıl olup, %56.3'ü erkekti. Tüm hastaların %50.6’sında hematolojik malignite vardı. Hastaların %31'inde kan kültürü pozitifliği saptandı. Tüm hastaların 51'i (%58.6) düşük riskli FN idi. Hastalarda komplikasyon oranı %40.2 ve mortalite oranı ise %25.3 idi. Risk skorlarına göre değerlendirildiğinde qSOFA skoruna, MASCC skoruna ve CİSNE skoruna göre sırası ile 69 (%79.3), 40 (%46) ve 7 (%8.1) hasta düşük riskli olarak sınıflandırıldı. Düşük riskli febril nötropenili hastalarında qSOFA skoru %96.08 ile en yüksek duyarlılığa, MASCC %85 ile en yüksek PPV'ye ve CİSNE skoru %88.89 ile en yüksek özgüllüğe sahipti. Sonuç: MASCC, CİSNE ve qSOFA skorlarının düşük riskli nötropeni hastalarını belirlemede makul bir ayırt edici gücü vardır. Skorlama sistemlerinin klinik tecrübe ve onkologlarla iletişim ile birlikte kullanılması, acil serviste düşük riskli nötropeni hastalarının tanınırlılığının yüzdesini daha da artıracaktır.

Keywords

• MASCC
• CİSNE
• qSOFA
• Febril nötropeni
• Acil servis

Scoring Systems Identifying the Low-Risk Febril Neutropenia Patients in the Emergency Department: Usefulness of MASCC, CISNE and qSOFA

Abstract

Objective: We aimed to investigate the effectiveness of quick Sequential Organ Failure Assessment (qSOFA), Multinational Association for Supportive Care in Cancer (MASCC), and Clinical Index of Stable Febrile Neutropenia (CISNE) scores in identifying the low-risk febrile neutropenia patients among patients with chemotherapy-associated neutropenia in the emergency department setting. Material and Method: The risk scores of the patients were calculated and divided into low-risk and high-risk categories according to the guidelines. Serious complications and 30-day mortality were recorded. Patients who survived and did not develop any serious complications were defined as low risk FN. Results: The median age of the patients was 63 years, and 56.3% were male. Of all patients, 50.6% had hematological malignancy. Blood culture positivity was detected in 31% of the patients. Of all patients, 51 (58.6%) were low-risk FN. The complication rate in patients was 40.2%, while the mortality rate was 25.3%. When evaluated according to the risk scores, 69 (79.3%) patients with qSOFA, 40 (46%) patients with MASCC and 7 (8.1%) patients with CISNE were classified as low risk. The qSOFA score had the highest sensitivity with 96.08%, MASCC had the highest PPV with 85%, and the CISNE score had the highest specificity with 88.89% in patients with low-risk febrile neutropenia. Conclusion: MASCC, CISNE and qSOFA scores have reasonable discriminating power in identifying low-risk neutropenia patients. The combined use of scoring systems with the clinical gestalt and communication with oncologists will further increase the percentage of the recognized low-risk neutropenia patients in the emergency department.

Keywords

• MASCC
• CISNE
• qSOFA
• Febrile neutropenia
• Emergency department

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