C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms

Combariza, Juan Felipe; Lombana, Milton; Pino, Luis Eduardo; Arango, Myrtha

doi:10.1007/s00520-014-2454-2

Cited by 21 publications

(13 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…CRP is an acute phase protein that is elevated in the blood plasma in response to inflammation. High values predict poor prognosis in cancer patients with febrile neutropenia [32, 33]. In our study we analyzed the CRP levels of colonized and noncolonized patients and found higher CRP levels in colonized patients.…”

Section: Discussionmentioning

confidence: 94%

Colonization with multidrug resistant organisms determines the clinical course of patients with acute myeloid leukemia undergoing intensive induction chemotherapy

Balló¹,

Tarazzit²,

Stratmann³

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

IntroductionThe global spread of multidrug-resistant organisms (MDRO) complicates treatment and isolation measures in hospitals and has shown to increase mortality. Patients with disease- or therapy-related immunodeficiency are especially at risk for fatal infections caused by MDRO. The impact of MDRO colonization on the clinical course of AML patients undergoing intensive induction chemotherapy—a potentially curative but highly toxic treatment option—has not been systematically studied.Materials & methods312 AML patients undergoing intensive induction chemotherapy between 2007 and 2015 were examined for MDRO colonization. Patients with evidence for MDRO before or during the hospital stay of induction chemotherapy were defined as colonized, patients who never had a positive swab for MDRO were defined as noncolonized.ResultsOf 312 AML patients 90 were colonized and 130 were noncolonized. Colonized patients suffered from significantly more days with fever, spent more days on the intensive care unit and had a higher median C-reactive protein value during the hospital stay. These findings did not result in a prolonged length of hospital stay or an increased mortality rate for colonized patients. However, in a subgroup analysis, patients colonized with carbapenem-resistant enterobacteriaceae (CRE) had a significantly reduced 60- and 90-day, as well as 1- and 2-year survival rates when compared to noncolonized patients.ConclusionOur analysis highlights the importance of intensive MDRO screening especially in patients with febrile neutropenia since persisting fever can be a sign of MDRO-colonization. CRE-colonized patients require special surveillance, since they seem to be at risk for death.

show abstract

Section: Discussionmentioning

confidence: 94%

Colonization with multidrug resistant organisms determines the clinical course of patients with acute myeloid leukemia undergoing intensive induction chemotherapy

Balló¹,

Tarazzit²,

Stratmann³

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Biomarkers such as C‐reactive protein (CRP) and procalcitonin (PCT) have been used to fortify adult risk systems successfully . Three paediatric clinical decision rules have utilised biomarkers to guide risk stratification (CRP in two rules and PCT in one).…”

Section: Introductionmentioning

confidence: 99%

Updated systematic review and meta‐analysis of the predictive value of serum biomarkers in the assessment and management of fever during neutropenia in children with cancer

Arif

Phillips

2019

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Routinely measurable biomarkers as predictors for adverse outcomes in febrile neutropenia could improve management through risk stratification. This systematic review assesses the predictive role of biomarkers in identifying events such as bacteraemia, clinically documented infections, microbiologically documented infection, severe sepsis requiring intensive care or high dependency care and death. This review collates 8319 episodes from 4843 patients. C-reactive protein (CRP), interleukin (IL)-6, IL-8 and procalcitonin (PCT) consistently predict bacteraemia and severe sepsis; other outcomes have highly heterogeneous results. Performance of the biomarkers at admission using different thresholds demonstrates that PCT > 0.5 ng/mL offers the best compromise between sensitivity and specificity: sensitivity 0.67 (confidence interval [CI] 0.53-0.79) specificity 0.73 . Seventeen studies describe the use of serial biomarkers, with PCT having the greatest discriminatory role. Biomarkers, potentially with serial measurements, may predict adverse outcomes in paediatric febrile neutropenia and their role in risk stratification is promising.

show abstract

“…However, the Clinical Index of Stable Febrile Neutropenia (CISNE) scaore [29], the alternative to MASCC score, has poor sensitivity and thus has limited usefulness in high-risk patients. While prior investigators have validated the MASCC score in low-risk patients hospitalized for FN, its use in high-risk patients has been less frequently studied [30][31][32][33][34][35]. One validation study, with a goal of identifying high-risk patients who might be candidates for hematopoietic growth factor, correctly predicted 98.3% of low-risk patients and 86.4% of high-risk patients [30].…”

Section: Discussionmentioning

confidence: 99%

“…One validation study, with a goal of identifying high-risk patients who might be candidates for hematopoietic growth factor, correctly predicted 98.3% of low-risk patients and 86.4% of high-risk patients [30]. Other studies have (a) identified patients at a high risk of complications by calculating the score at 48 and 72 h, adding a measure of organ dysfunction [31]; (b) attempted to combine MASCC score of < 21 with Creactive protein or procalcitonin to predict poor outcomes [32][33][34]; and (c) examined MASCC score's calibration to identify the risk of mortality and the need for ICU level of care among patients with hematologic malignancies [35]. These studies were limited in that most were done in the ED setting, and none of them examined the use of goals of care discussions in patients with a high risk of poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

Use of MASCC score in the inpatient management of febrile neutropenia: a single-center retrospective study

Bhardwaj

Emmich

Knee

et al. 2021

Support Care Cancer

View full text Add to dashboard Cite

Purpose The Multinational Association for Supportive Care in Cancer (MASCC) score is used to risk stratify outpatients with febrile neutropenia (FN). However, it is rarely used in hospital settings. We aimed to describe management, use of MASCC score, and outcomes among hospitalized patients with FN. Methods We conducted a retrospective cohort study of patients with cancer and FN. We collected patient demographics, cancer characteristics, microbiological profile, MASCC score, utilization of critical care therapies, documentation of goals of care (GOC), and inpatient deaths. Outcomes associated with low-(≥ 21) versus high-risk (< 21) MASCC scores are presented as absolute differences. Results Of 193 patients, few (2%, n = 3) had MASCC scores documented, but when calculated, 52% (n = 101) had a high-risk score (< 21). GOC were discussed in 12% (n = 24) of patients. Twenty one percent (n = 40) required intermediate/ICU level of care, and 12% (n = 23) died in the hospital. Those with a low-risk score were 33% less likely to require intermediate/ICU care (95% CI 23 to 44%) and 19% less likely to die in the hospital (95% CI 10% to 27%) compared to those with high-risk score. Conclusions MASCC score was rarely used for hospitalized patients with FN, but high-risk score was associated with worse outcomes. Education efforts to incorporate MASCC score into the workflow may help identify patients at high risk for complications and help clinicians admit these patients to a higher level of care (e.g., intermediate/ICU care) or guide them to initiate earlier GOC discussions.

show abstract

C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms

Abstract: The MASCC risk score combined with the mean CRP value successfully identifies patients with febrile neutropenia and hematological malignancies and a high risk of death.

Cited by 21 publications

References 22 publications

Colonization with multidrug resistant organisms determines the clinical course of patients with acute myeloid leukemia undergoing intensive induction chemotherapy

Colonization with multidrug resistant organisms determines the clinical course of patients with acute myeloid leukemia undergoing intensive induction chemotherapy

Updated systematic review and meta‐analysis of the predictive value of serum biomarkers in the assessment and management of fever during neutropenia in children with cancer

Use of MASCC score in the inpatient management of febrile neutropenia: a single-center retrospective study

Contact Info

Product

Resources

About