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

Year 2021, Volume 3, Issue 3, 118 - 122, 01.11.2021
https://doi.org/10.38175/phnx.992230

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.

References

  • Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56-e93.
  • Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. JCO. 2018;36(14):1443-1453.
  • de Naurois J, Novitzky-Basso I, Gill MJ, Marti FM, Cullen MH, Roila F. Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2010;21 Suppl 5:v252-v256.
  • Teuffel O, Ethier MC, Alibhai SMH, Beyene J, Sung L. Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol. 2011;22(11):2358-2365.
  • Flowers CR, Karten C. Communicating safe outpatient management of fever and neutropenia. J Oncol Pract. 2013;9: 207-210.
  • Pherwani N, Ghayad JM, Holle LM, Karpiuk EL. Outpatient management of febrile neutropenia associated with cancer chemotherapy: risk stratification and treatment review. Am J Health Syst Pharm. 2015;72(8):619-631.
  • Freifeld A, Marchigiani D, Walsh T, Chanock S, Lewis L, Hiemenz J, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med. 1999;341(5):305-311.
  • Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000;18(16):3038-3051.
  • Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, Antonio M, Font C, Biosca M, et al. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol. 2015;33(5):465-471.
  • Singer M, Deutschman CS, Seymour CW, Hari MS, Annane D, Bauer M et al. The third ınternational consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810.
  • Can N, Yolcu Ş, Çetin Beceren NG, Tomruk Ö. Determination of Sociodemographic Characteristics of Cancer Patients Applying to Our Emergency Department and the Relationship Between Emergency Applications. Bozok Medical Journal. 2013;2:6-11.
  • Tokocin O, Cakmak F, Ipekci A, Tihan DN, Ceylan D, Sutasir MN, et al. Factors affecting the morbidity and mortality of malignancy patients admitted to the emergency department. Phnx Med J. 2019;1:8-14.
  • Liu Z, Meng Z, Li Y, Zhao J, Wu S, Gou S, et al. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis. Scand J Trauma Resusc Emerg Med. 2019;27(1):51.
  • Lee SJ, Kim JH, Han SB, Paik JH, Durey A. Prognostic Factors Predicting Poor Outcome in Cancer Patients with Febrile Neutropenia in the Emergency Department: Usefulness of qSOFA. J Oncol. 2018;2018:2183179.
  • Kim M, Ahn S, Kim WY, Sohn CH, Seo DW, Lee YS, et al. Predictive performance of the quick Sequential Organ Failure Assessment score as a screening tool for sepsis, mortality, and intensive care unit admission in patients with febrile neutropenia. Support Care Cancer. 2017;25(5):1557-1562.
  • Cetintepe T, Cetintepe L, Solmaz S, Calık S, Ugur MC, Gediz F, et al. Determination of the relationship between mortality and SOFA, qSOFA, MASCC scores in febrile neutropenic patients monitored in the intensive care unit. Support Care Cancer. 2021;29:4089-4094.
  • Ahn S, Rice TW, Yeung SJ, Cooksley T. Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Support Care Cancer. 2018;26(5):1465-1470.
  • Moon H, Choi YJ, Sim SH. Validation of the Clinical Index of Stable Febrile Neutropenia (CISNE) model in febrile neutropenia patients visiting the emergency department. Can it guide emergency physicians to a reasonable decision on outpatient vs. inpatient treatment?. PLoS One. 2018;13(12):e0210019.
  • Mohindra R, Mathew R, Yadav S, Aggarwal P. CISNE versus MASCC: Identifying low risk febrile neutropenic patients. Am J Emerg Med. 2020;38(11):2259-2263.
  • Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, et al Application of the MASCC and CISNE risk-stratification scores to ıdentify low-risk febrile neutropenic patients in the emergency department. Ann Emerg Med. 2017;69(6):755-764.

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

Year 2021, Volume 3, Issue 3, 118 - 122, 01.11.2021
https://doi.org/10.38175/phnx.992230

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.

References

  • Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56-e93.
  • Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. JCO. 2018;36(14):1443-1453.
  • de Naurois J, Novitzky-Basso I, Gill MJ, Marti FM, Cullen MH, Roila F. Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2010;21 Suppl 5:v252-v256.
  • Teuffel O, Ethier MC, Alibhai SMH, Beyene J, Sung L. Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol. 2011;22(11):2358-2365.
  • Flowers CR, Karten C. Communicating safe outpatient management of fever and neutropenia. J Oncol Pract. 2013;9: 207-210.
  • Pherwani N, Ghayad JM, Holle LM, Karpiuk EL. Outpatient management of febrile neutropenia associated with cancer chemotherapy: risk stratification and treatment review. Am J Health Syst Pharm. 2015;72(8):619-631.
  • Freifeld A, Marchigiani D, Walsh T, Chanock S, Lewis L, Hiemenz J, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med. 1999;341(5):305-311.
  • Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000;18(16):3038-3051.
  • Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, Antonio M, Font C, Biosca M, et al. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol. 2015;33(5):465-471.
  • Singer M, Deutschman CS, Seymour CW, Hari MS, Annane D, Bauer M et al. The third ınternational consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810.
  • Can N, Yolcu Ş, Çetin Beceren NG, Tomruk Ö. Determination of Sociodemographic Characteristics of Cancer Patients Applying to Our Emergency Department and the Relationship Between Emergency Applications. Bozok Medical Journal. 2013;2:6-11.
  • Tokocin O, Cakmak F, Ipekci A, Tihan DN, Ceylan D, Sutasir MN, et al. Factors affecting the morbidity and mortality of malignancy patients admitted to the emergency department. Phnx Med J. 2019;1:8-14.
  • Liu Z, Meng Z, Li Y, Zhao J, Wu S, Gou S, et al. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis. Scand J Trauma Resusc Emerg Med. 2019;27(1):51.
  • Lee SJ, Kim JH, Han SB, Paik JH, Durey A. Prognostic Factors Predicting Poor Outcome in Cancer Patients with Febrile Neutropenia in the Emergency Department: Usefulness of qSOFA. J Oncol. 2018;2018:2183179.
  • Kim M, Ahn S, Kim WY, Sohn CH, Seo DW, Lee YS, et al. Predictive performance of the quick Sequential Organ Failure Assessment score as a screening tool for sepsis, mortality, and intensive care unit admission in patients with febrile neutropenia. Support Care Cancer. 2017;25(5):1557-1562.
  • Cetintepe T, Cetintepe L, Solmaz S, Calık S, Ugur MC, Gediz F, et al. Determination of the relationship between mortality and SOFA, qSOFA, MASCC scores in febrile neutropenic patients monitored in the intensive care unit. Support Care Cancer. 2021;29:4089-4094.
  • Ahn S, Rice TW, Yeung SJ, Cooksley T. Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Support Care Cancer. 2018;26(5):1465-1470.
  • Moon H, Choi YJ, Sim SH. Validation of the Clinical Index of Stable Febrile Neutropenia (CISNE) model in febrile neutropenia patients visiting the emergency department. Can it guide emergency physicians to a reasonable decision on outpatient vs. inpatient treatment?. PLoS One. 2018;13(12):e0210019.
  • Mohindra R, Mathew R, Yadav S, Aggarwal P. CISNE versus MASCC: Identifying low risk febrile neutropenic patients. Am J Emerg Med. 2020;38(11):2259-2263.
  • Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, et al Application of the MASCC and CISNE risk-stratification scores to ıdentify low-risk febrile neutropenic patients in the emergency department. Ann Emerg Med. 2017;69(6):755-764.

Details

Primary Language English
Subjects Emergency Medicine, Hematology
Journal Section Research Articles
Authors

Afşın İPEKCİ (Primary Author)
iSTANBUL UNIVERSITY-CERRAHPAŞA, CERRAHPAŞA FACULTY OF MEDICINE, DEPARTMENT OF EMERGENCY MEDICINE, İSTANBUL, TURKEY
0000-0001-6125-4061
Türkiye


Altuğ KANBAKAN
Emergency Service, Yuksekova State Hospital, Hakkari, Turkey
0000-0002-1063-3018
Türkiye


Yonca Senem AKDENİZ
iSTANBUL UNIVERSITY-CERRAHPAŞA, CERRAHPAŞA FACULTY OF MEDICINE, DEPARTMENT OF EMERGENCY MEDICINE, İSTANBUL, TURKEY
0000-0002-4843-1155
Türkiye


Fatih ÇAKMAK
iSTANBUL UNIVERSITY-CERRAHPAŞA, CERRAHPAŞA FACULTY OF MEDICINE, DEPARTMENT OF EMERGENCY MEDICINE, İSTANBUL, TURKEY
0000-0002-0333-3834
Türkiye


Serap BİBEROĞLU
iSTANBUL UNIVERSITY-CERRAHPAŞA, CERRAHPAŞA FACULTY OF MEDICINE, DEPARTMENT OF EMERGENCY MEDICINE, İSTANBUL, TURKEY
0000-0003-4709-3315
Türkiye


Seda ÖZKAN
iSTANBUL UNIVERSITY-CERRAHPAŞA, CERRAHPAŞA FACULTY OF MEDICINE, DEPARTMENT OF EMERGENCY MEDICINE, İSTANBUL, TURKEY
0000-0003-1835-8820
Türkiye


İbrahim İKİZCELİ
iSTANBUL UNIVERSITY-CERRAHPAŞA, CERRAHPAŞA FACULTY OF MEDICINE, DEPARTMENT OF EMERGENCY MEDICINE, İSTANBUL, TURKEY
0000-0002-9825-4716
Türkiye

Supporting Institution Yok
Project Number Yok
Publication Date November 1, 2021
Application Date September 7, 2021
Acceptance Date September 27, 2021
Published in Issue Year 2021, Volume 3, Issue 3

Cite

AMA İpekci A. , Kanbakan A. , Akdeniz Y. S. , Çakmak F. , Biberoğlu S. , Özkan S. , İkizceli İ. Scoring Systems Identifying the Low-Risk Febril Neutropenia Patients in the Emergency Department: Usefulness of MASCC, CISNE and qSOFA. Phnx Med J. 2021; 3(3): 118-122.

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