Patient selection: chemotherapy-induced neutropenia
Criteria for febrile neutropenia:
(1) absolute neutrophil count < 500 per µL OR (< 1,000 per µL AND predicted fall to < 500 per µL in 2-3 days)
(2) body temperature > 38.0°C by tympanic thermometer
Outcomes: adverse event (MASCC risk index) including death, bacteremia
Parameters:
(1) age in years
(2) serum procalcitonin in ng/mL (method and reference range not stated)
(3) ECOG performance status
(4) oral mucositis grade
(5) systolic blood pressure in mm Hg
(6) respiratory rate in breaths per minute
|
Parameter
|
Finding
|
Points
|
|
age in years
|
< 60 years
|
0
|
|
|
>= 60 years
|
2
|
|
procalcitonin
|
< 0.5 ng/mL
|
0
|
|
|
>= 0.5 ng/mL
|
5
|
|
ECOG performance
|
0 or 1
|
0
|
|
|
2 to 4
|
2
|
|
oral mucositis
|
Grade 0 to 2
|
0
|
|
|
Grade 3 or 4
|
3
|
|
systolic blood pressure
|
>= 90 mm Hg
|
0
|
|
|
< 90 mm Hg
|
3
|
|
respiratory rate
|
< 23 breaths per minute
|
0
|
|
|
>= 23 breaths per minute
|
3
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• The higher the score the greater the risk of an adverse event.
|
Score
|
Risk Class
|
Unfavorable Outcome
|
|
0 to 2
|
low risk (I)
|
6%
|
|
3 to 8
|
intermediate risk (II)
|
27%
|
|
>= 9
|
high risk (III)
|
68%
|
Performance:
• The area under the ROC curve for any adverse event ranged from 0.80 to 0.84.
• The area under the ROC curve for bacteremia ranged was around 0.86.
