Abstract
IntroductionCancer patients with chemotherapy-induced febrile neutropenia are a heterogeneous group with a significant risk of serious medical complications. In these patients, the Multinational Association for Supportive Care in Cancer (MASCC) score is the most widely used tool for risk-stratification. The aim of this prospective study was to analyse the value of procalcitonin (PCT) and lipopolysaccharide binding protein (LBP) to predict serious complications and bacteraemia in cancer patients with febrile neutropenia, compared with MASCC score.Materials and methodsData were collected from 111 episodes of febrile neutropenia admitted consecutively to the emergency department. In all of them, MASCC score was calculated and serum samples were collected for measurement of PCT and LBP by well-established methods. The main and secondary outcomes were the development of serious complications and bacteraemia, respectively.ResultsA serious complication occurred in 20 (18%) episodes and in 16 (14%) bacteraemia was detected. Areas under the receiver operating characteristic curve (ROC AUC) of MASCC score, PCT and LBP to select low-risk patients were 0.83 (95% confidence interval (CI): 0.74 - 0.89), 0.85 (95% CI: 0.77 - 0.91) and 0.70 (95% CI: 0.61 - 0.78), respectively. For bacteraemia, MASCC score, PCT and LBP showed ROC AUCs of 0.74 (95% CI: 0.64 - 0.82), 0.86 (95% CI: 0.78 - 0.92) and 0.76 (95% CI: 0.67 - 0.83), respectively.ConclusionA single measurement of PCT performs similarly as MASCC score to predict serious medical complications in cancer patients with febrile neutropenia and can be a useful tool for risk stratification. Besides, low PCT concentrations can be used to rule-out the presence of bacteraemia.
Highlights
Cancer patients with chemotherapy-induced febrile neutropenia are a heterogeneous group with a significant risk of serious medical complications
Areas under the receiver operating characteristic curve (ROC AUC) of Multinational Association for Supportive Care in Cancer (MASCC) score, PCT and lipopolysaccharide binding protein (LBP) to select low-risk patients were 0.83 (95% confidence interval (CI): 0.74 - 0.89), 0.85 and 0.70, respectively
MASCC score, PCT and LBP showed ROC AUCs of 0.74, 0.86 and 0.76, respectively
Summary
Cancer patients with chemotherapy-induced febrile neutropenia are a heterogeneous group with a significant risk of serious medical complications In these patients, the Multinational Association for Supportive Care in Cancer (MASCC) score is the most widely used tool for risk-stratification. Association for Supportive Care in Cancer (MASCC) risk index score, based on seven independent predictive factors that can be assessed at fever onset, without laboratory results [2]. It has limitations: some of its components are objective (e.g., patient age), but two components are inherently subjective: burden of disease and presence of dehydration requiring iv. The use of MASCC risk score has been recommended in the most recent international guidelines, Baugh et al have recently concluded that guideline concordance was low among low-risk patients, with management, including admission to hospital and parenteral antibiotic regimens, tending to be more aggressive than recommended [4,5]
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