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

Abstract

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.

Can MASCC and CISNE scores predict delays of lung cancer chemotherapy after febrile neutropenia?

“…25 Another study in the US also demonstrated a higher inpatient death rate in a high-risk group based on the MASCC score (20.8% vs. 2.2%). 26 These results are not surprising because the MASCC score includes indicators of circulatory and organ failure, such as hypotension and the presence of dehydration, which are essential for assessing the severity of sepsis. 27 On the other hand, no deaths were directly related to FN in the present study.…”

“… 24 The MASCC score is also useful for predicting poor outcomes due to FN, such as septic shock, respiratory failure, need for intensive care, and death. 25 , 26 In a study from Turkey, 51/86 patients with MASCC scores <21 died due to FN, whereas only 13 of 114 patients with MASCC scores ≥21 died. 25 Another study in the US also demonstrated a higher inpatient death rate in a high‐risk group based on the MASCC score (20.8% vs. 2.2%).…”

“…Severe neutropenia and mucosal damage at the onset of FN, especially in the presence of bacteremia, have been associated with poor prognosis with a high mortality rate of 5–18% 24 . The MASCC score is also useful for predicting poor outcomes due to FN, such as septic shock, respiratory failure, need for intensive care, and death 25,26 . In a study from Turkey, 51/86 patients with MASCC scores <21 died due to FN, whereas only 13 of 114 patients with MASCC scores ≥21 died 25 .…”

Cuidados no uso do dispositivo Pegfilgrastim On-body injector na profilaxia de neutropenia induzida por quimioterapia: revisão de escopo

“…a) paciente assintomático à paciente apresentando sintomas leves, moderados ou graves; b) ausência de hipotensão; c) ausência de doença pulmonar obstrutiva crônica; d) portador de tumor sólido; e) ausência de infecção fúngica; f) ausência de desidratação; g) não hospitalizados ao aparecimento da febre; h) idade menor que 60 anos.Com a aplicação do índice de MASCC pela equipe médica, o indivíduo com NF pode ser classificado como neutropênico de baixo risco, de risco intermediário e de alto risco.Nesse caminho,Bhardwaj et al (2021), publicaram um estudo de coorte retrospectivo que teve como objetivo descrever o manejo do escore MASCC e os resultados entre pacientes hospitalizados com NF. De 193 pacientes, 52% (n = 101) tiveram uma pontuação de alto risco (<21).…”

“…O escore MASCC foi raramente usado para pacientes hospitalizados com NF, mas o escore de alto risco foi associado a piores desfechos. Os autores destacam esforços em educação para incorporar a pontuação MASCC no fluxo de trabalho, com intuito de ajudar a identificação de pacientes com alto risco de complicações e guiar a equipe médica na conduta clínica(BHARDWAJ, et al, 2021).Pensando ainda na predição de risco para neutropenia febril grave, biomarcadores como proteína C-reativa (PCR), teste de procalcitonina (PCT) e interleucina (IL-6) estão sendo estudados e já trazem resultados animadores. A revisão sistemática com metanálise realizada porWu, et al (2015), avaliou o uso de biomarcadores sanguíneos para identificação de infecção bacteriana em pacientes com neutropenia febril.…”