Comparison of CISNE and MASCC Score in Predicting Complications on Post Chemotherapy Febrile Neutropenia

Authors

  • Sharifah Shakinah Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Erni Juwita Nelwan Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Anna Mira Lubis Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Robert Sinto Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Khie Chen Lie Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Keywords:

infectious disease, medical oncology

Abstract

Background: Febrile neutropenia (FN) is an oncologic emergency which commonly occurrs in patients who undergo chemotherapy, with a mortality rate of 12.5%. Risk stratification in FN plays an important role in increasing the accuracy of therapy. This study aims to compare the performance between CISNE score and MASCC score in predicting complications on post-chemotherapy FN in solid and hematologic malignancy.  Methods: This is a retrospective cohort study on FN patients undergoing inpatient treatment at Cipto Mangunkusumo Hospital between July 2015 and December 2019. Basic demographic and clinical data were collected from medical records. Subjects were grouped based on the CISNE and MASCC score, and complications during hospitalization were recorded. Predictive performance of each score was analyzed and compared using area of under curve.  Results: CISNE score showed a better performance both in solid malignancy with AUC of CISNE score (0.80 CI 95% 0.73-0.88, p = 0.00) compared to AUC of MASCC score (0.68; 95% CI 0.59 – 0,78, p = 0.00) and in hematologic malignancy with AUC of CISNE score (0.85; 95% CI 0.77 - 0.93, p = 0.00) and AUC MASCC score (0.65 ; 95% CI 0.54 - 0.76, p = 0.007). Conclusion: CISNE score showed a better performance compared to MASCC score in predicting in-hospital complication in both solid and hematologic malignancy with cut-off point of 2. 

References

Schelenz S, Giles D, Abdallah S. Epidemiology, management and economic impact of febrile neutropenia in oncology patients receiving routine care at a regional UK cancer centre. Ann Oncol. 2012;23(7):1889–93.

Carmona-Bayonas A, Jiménez-Fonseca P, Echaburu JV, 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. Journal of Clinical Oncology. 2015;33(5):465–70.

Klastersky J, Paesmans M, Rubenstein EB, et al. The multinational association for supportive care in cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. JCO. 2000;18(16):3038–51.

Klastersky, J N J, Rolston, K, Rapoport, B, Maschmeyer, G, Appro, M, Herrstedt, J. Management of febrile neutropaenia: ESMO clinical practice guidelines ESMO. Ann Oncol. 27(5):111–8.

Freifeld AG, Bow EJ, Sepkowitz KA, 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):e56–93.

Bitar RA. Utility of the multinational association for supportive care in cancer (MASCC) risk index score as a criterion for nonadmission in febrile neutropenic patients with solid tumors. Perm J. 2015;19(3):37–47.

Ahn S, Rice TW, Yeung SCJ, 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):1465–70.

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.

Zheng B, Toarta C, Cheng W, Taljaard M, Reaume N, Perry JJ. Accuracy of the Multinational Association of Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores for predicting serious complications in adult patients with febrile neutropenia: A systematic review and meta-analysis. Critical Reviews in Oncology/Hematology. 2020;149:102922.

Blume JD. Bounding sample size projections for the area under a ROC curve. J Stat Plan Inference. 2009;139(1):711–21.

Justiz Vaillant AA, Zito PM. Neutropenia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 May 27]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK507702/

Koppaka D, Kuntegowdanahalli LC, Lokanath D, et al. Assessment and comparison of CISNE model versus MASCC model in clinically stable febrile neutropenia patients. Annals of Oncology. 2018;29:ix129.

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):1–12.

Coyne CJ, Le V, Brennan JJ, et al. Application of the MASCC and CISNE risk-stratification scores to identify low-risk febrile neutropenic patients in the emergency department. Ann Emerg Med. 2017;69(6):755–64.

Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela J, et al. Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors. Clin Transl Oncol. 2017;19(3):386–95.

Al-Ahwal MS, Johar I, Al-Sayws, Fatih. Febrile neutropenia comparison between solid tumours and hematological malignancies. Pan Arab Medical Journal. 2005;2(4):4–7.

Hassan BAR, Yusoff ZBM, Othman SB. A close look at neutropenia among cancer patients — Risk factor and management. Updates on Cancer Treatment. 2015 Oct 28.

Budiana ING, Febiani M. Febrile neutropenia pada pasien pascakemoterapi. Indonesian Journal of Cancer. 2017;11(2):77–82.

Hansen BA, Wendelbo Ø, Bruserud Ø, Hemsing AL, Mosevoll KA, Reikvam H. Febrile neutropenia in acute leukemia. Epidemiology, etiology, pathophysiology and treatment. Mediterr J Hematol Infect Dis. 2019;12(1).

Punnapuzha S, Edemobi PK, Elmoheen A. Febrile neutropenia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2019 Dec 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541102/

Vehreschild JJ. Pneumonia and lung infiltrates in neutropenic patients: Many stones unturned. Annals ATS. 2013;10(5):493–5.

Rodrigues FG, Dasilva G, Wexner SD. Neutropenic enterocolitis. World J Gastroenterol. 2017;23(1):42–7.

Cancer NCC for. Diagnosis of neutropenic sepsis [Internet]. Neutropenic sepsis: Prevention and management of neutropenic sepsis in cancer patients. National Institute for Health and Clinical Excellence (UK); 2012 [cited 2020 Jul 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK373673/

Kochanek M, Schalk E, von Bergwelt-Baildon M, et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2019;98(5):1051–69.

Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection. 2008;36(5):396–407.

Ahn S, Rice TW, Yeung SCJ, 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):1465–70.

Mohindra R, Mathew R, Yadav S, Aggarwal P. CISNE versus MASCC: Identifying low risk febrile neutropenic patients. The American Journal of Emergency Medicine. 2019 Nov 30.

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Published

2024-10-25

How to Cite

Shakinah, S., Nelwan, E. J., Lubis, A. M., Sinto, R., & Lie, K. C. (2024). Comparison of CISNE and MASCC Score in Predicting Complications on Post Chemotherapy Febrile Neutropenia. Acta Medica Indonesiana, 56(3), 341. Retrieved from https://www.actamedindones.org/index.php/ijim/article/view/2772

Issue

Vol. 56 No. 3 (2024): Acta Medica Indonesiana

Section

ORIGINAL ARTICLE

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