Comparison of CISNE and MASCC Scoring Systems for Febrile Neutropenia Risk Assessment
CISNE (Clinical Index of Stable Febrile Neutropenia) is superior to MASCC (Multinational Association of Supportive Care in Cancer) for predicting complications in patients with seemingly stable febrile neutropenia, with CISNE demonstrating significantly better discriminatory power (AUC 0.868 vs 0.721 for MASCC). 1
Overview of Both Scoring Systems
CISNE Score
- Specifically designed for patients with solid tumors and seemingly stable episodes of febrile neutropenia 1
- Uses six variables to predict risk of serious complications:
- ECOG performance status ≥2 (2 points)
- Chronic obstructive pulmonary disease (1 point)
- Chronic cardiovascular disease (1 point)
- Mucositis grade ≥2 (1 point)
- Monocytes <200/μL (1 point)
- Stress-induced hyperglycemia (2 points) 1
- Risk stratification:
- Low risk: 0 points (1.1% complication rate)
- Intermediate risk: 1-2 points (6.1-6.2% complication rate)
- High risk: ≥3 points (32.5-36% complication rate) 1
MASCC Score
- Older scoring system developed by the Multinational Association of Supportive Care in Cancer 2
- Uses a different set of clinical parameters to assess risk in febrile neutropenia patients
- Higher scores (≥21) indicate lower risk of complications 1
- Less specific for "seemingly stable" patients compared to CISNE 1
Comparative Performance
Discriminatory Power
- CISNE demonstrates superior discriminatory power with AUC of 0.868 (95% CI, 0.827-0.903) compared to MASCC's AUC of 0.721 (95% CI, 0.669-0.768) 1
- The difference is statistically significant (P = 0.002) in favor of CISNE 1
- This superior performance has been validated in multiple studies across different cancer types 3, 4
Sensitivity and Specificity
- In gynecologic oncology patients:
- CISNE shows particularly high positive predictive value when using the more conservative cut-off (cut-off 1) 5
Performance Across Different Cancer Types
- CISNE maintains consistent predictive performance across different types of tumors and infections 4
- Recent studies show CISNE performs well in both solid and hematologic malignancies:
- Solid malignancies: AUC 0.80 (95% CI 0.73-0.88)
- Hematologic malignancies: AUC 0.85 (95% CI 0.77-0.93) 3
- MASCC showed lower performance in both categories:
- Solid malignancies: AUC 0.68 (95% CI 0.59-0.78)
- Hematologic malignancies: AUC 0.65 (95% CI 0.54-0.76) 3
Clinical Implications and Recommendations
- CISNE is the preferred tool for risk stratification in seemingly stable febrile neutropenia patients due to its superior discriminatory power 1, 3
- For optimal safety, consider using CISNE with a cut-off of 2 (high risk ≥3) which provides better sensitivity (85.7%) while maintaining reasonable specificity 5
- In settings where maximum specificity is desired, combining MASCC with CISNE may provide the highest positive predictive value (92.9%) 5
- CISNE's robust performance across different tumor types and infection presentations makes it a reliable tool in diverse oncology settings 4
- Patients classified as low-risk by CISNE may be candidates for outpatient management, potentially reducing hospitalization costs and improving quality of life 5
Common Pitfalls and Caveats
- CISNE was originally validated in seemingly stable patients - its performance may differ in obviously unstable patients 1
- Neither scoring system should replace clinical judgment, particularly in patients with rapidly evolving clinical status 1, 5
- Different cut-off points for CISNE (0 vs <3) significantly affect sensitivity and specificity profiles - choose the appropriate cut-off based on your clinical setting and risk tolerance 5
- When using combined scoring approaches (MASCC + CISNE), be aware that this increases complexity without necessarily improving overall predictive performance 5
- Regular reassessment is essential regardless of initial risk stratification, as clinical status can change rapidly in neutropenic patients 1