From the Guidelines
Febrile neutropenia is classified as high-risk or low-risk based on the patient's clinical presentation and anticipated duration of neutropenia.
Risk Classification Criteria
The following criteria are used to classify febrile neutropenia as high-risk or low-risk:
- High-Risk: + Profound neutropenia (ANC <100 cells/mm3) anticipated to extend >7 days + Presence of co-morbid medical problems, such as hemodynamic instability, oral or gastrointestinal mucositis, gastrointestinal symptoms, neurologic or mental-status changes, intravascular catheter infection, new pulmonary infiltrate or hypoxemia, or underlying chronic lung disease + MASCC score <21
- Low-Risk: + Anticipated brief (<7 days) periods of neutropenia + Few comorbidities + MASCC score ≥21 As noted by the Infectious Diseases Society of America in their 2010 update 1, 2, 3, 4, 5, the MASCC scoring system is a useful tool for risk stratification, with a score <21 indicating high risk and a score ≥21 indicating low risk.
From the Research
Risk Classification for Febrile Neutropenia
The risk classification for febrile neutropenia can be determined using various scoring systems, including the Multinational Association for Supportive Care in Cancer (MASCC) Index and the Clinical Index of Stable Febrile Neutropenia (CISNE) score 6. These scoring systems help to stratify patients into low-risk and high-risk categories, which can inform management decisions.
Low-Risk Febrile Neutropenia
- Patients with a low risk of complications can be managed with oral combination therapy in an ambulatory or home care setting 7.
- The MASCC score can be used to identify low-risk patients, with a score of ≤21 predicting a <5% risk for severe complications 7.
- Low-risk patients can be discharged from the emergency department with oral antibiotics, as long as they have a stable condition and no signs of infection 8, 9.
High-Risk Febrile Neutropenia
- Patients with a high risk of complications require hospital admission and intravenous antibiotic therapy 7.
- High-risk patients may have a higher risk of mortality, with one study reporting a 5.1% mortality rate in this group 8.
- The CISNE score may be more sensitive than the MASCC score in identifying high-risk patients, but it has a lower specificity 6.
Risk Stratification Tools
- The MASCC score and CISNE score are two commonly used risk stratification tools for febrile neutropenia 6.
- These tools can help to identify patients who are at low risk of complications and can be safely discharged from the emergency department 8, 9.
- The use of risk stratification tools can help to improve patient outcomes and reduce unnecessary hospitalizations 6.