Background Neutropenic fever is a common complication in the treatment of malignancy that has historically carried a high rate of mortality. The Multinational Association for Supportive Care in Cancer (MASCC) Risk Index for Febrile Neutropenia has been used to reliably identify patients with chemotherapy-induced febrile neutropenia who are at low risk of serious medical complications. It is often used in the outpatient or emergency room setting to help determine which patients with solid tumors may be able to avoid hospital admission and be appropriate for outpatient management of febrile neutropenia. The MASCC Risk Index is not recommended for use in hematologic malignancy due to its poor positive predictive value for serious medical complications in this population. This study seeks to use this score to retrospectively risk-stratify hematologic malignancy patients and determine if the MASCC risk index is predictive of length of hospitalization or mortality. Methods This is an IRB approved retrospective review that identified patients with a hematologic malignancy who presented to the outpatient clinic or the emergency department of an academic medical center with neutropenic fever between 1/1/2017 and 12/31/2017. Chart review was performed to determine each patient's MASCC risk index in order to stratify as high risk ( =21). This was then compared to length of stay and mortality data. Charlson comorbidity index (CCI) was used to compare baseline characteristics of the patients. Results 73 patients met the inclusion criteria. 31 (42%) patients were deemed high risk and 42 (58%) were deemed low risk by MASCC stratification. There was no difference in length of stay (LOS) between high risk and low risk groups (mean LOS 8.45 days and 8.12 days, respectively, p=0.894). In the first 30 days from admission, 5 patients (16%) died, all from the high risk group. Overall survival was significantly worse in the high risk group with a hazard ratio 4.48 (95% CI, 1.77 – 11.37), and in patients aged 75-84 with a hazard ratio of 3.622 (95% CI, 1.21 – 10.827). High Charlson Comorbidity index scores (liver disease, cerebrovascular disease, peripheral vascular disease, renal disease, paralysis, dementia, mild liver disease, congestive heart failure, COPD, diabetes) did not correlate with worsened survival. Conclusion This study shows that even when not being used to prevent hospitalization, the MASCC risk index has utility in predicting which patients have the highest risk of mortality after developing neutropenic fever.
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