Performance of MASCC score and other factors for identifying low-risk febrile-neutropenic cancer patients.

Abstract

e19533 Background: The standard empirical broad-spectrum-intravenous-antibiotic (AB) treatment and hospitalisation though safe lead to over-treatment of substantial group of patients. Validation of parameters to identify low-risk febrile neutropenia (FN) that can be safely treated in an outpatient setting with minimal/no AB treatment needed. Methods: A retrospective analysis to validate risk assessment model in FN patients from January 2007 to December 2008 done. Inclusion criteria were histologic diagnosis of malignancy, FN secondary to chemotherapy, absolute neutrophil count of ≤500/μl, axillary temperature of ≥38° C and age ≥ 14years. Other clinical and lab parameters were explored for risk stratification during FN episodes .Receiver operating characteristic curves were used to find the thresholdvalue and Chisquare analysis was done to find association between outcome and the parameters. Results: A total of 178 FN episodes were documented; 22 in solid tumors while 156 in haematolymphoid malignancies. Cultures were positive in 59 episodes with Escherichia-coli being the commonest organism. Risk stratification was done by Multinational Association of Supportive Care in Cancer (MASCC) risk index score. The association between MSACC score and risk stratification could not be established (p = not significant).The total no of complications were 23 (Sepsis 22, Mortality 23). Other factors found to be significantly associated with high risk of complications were mucositis (p = 0.03), maximum temperature ≥ 103°F (p = 0.01), tachycardia (p<0.001),tachypnoea (p = <0.001), age (p = 0.006), high dose of steroid (p<0.001), total duration of fever (≥2.5 days (for which Sensitivity(S) and specificity (Sp) 87% and 81% respectively), serum creatinine (≥0.45mg%, S = 100%, Sp = 97%), bilirubin (≥0.5, S = 100%. Sp = 90%) requirement of second line antibiotics (p = 0.02), intensive care (p = <0.001), ventilatory support (p<0.001) and requirement of packed cell transfusion (p = 0.02). Conclusions: The MASCC risk index score could not be validated in this population while other clinical and lab parameters were found to have strong association in risk stratification of cancer patients during FN episodes. No significant financial relationships to disclose.