Abstract
Objective
The objective of this study is to assess the prognostic usefulness of the Multinational Association of Supportive Care in Cancer (MASCC) risk score in association with the value of C-reactive protein (CRP) to identify high-risk patients with febrile neutropenia and hematologic neoplasms.
Methods
A retrospective cohort study in which the MASCC score and the CRP values were used to assess the mortality risk at 30 days among patients with febrile neutropenia and hematologic malignancies was performed.
Results
Two hundred thiry-seven patients with febrile neutropenia were analyzed; the mortality rate within 30 days was 9 %. High-risk patients according to the MASCC score were significantly more likely to experience adverse outcomes, such as being transferred to the intensive care unit (RR 3.55; CI 95 % 2.73–6.62, p < 0.001) and death (RR 2.21; CI 95 % 1.74–2.79, p < 0.001). Multivariate analysis showed a strong association between the high-risk group identified by the MASCC score (HR 3.0; CI 95 % 1.12–13.54, p = 0.032) and the mean levels of CRP (HR 17; CI 95 % 2.21–136.48, p = 0.007) and survival. The survival rate within 30 days was 100 % for the patients with a low-risk MASCC score and a mean CRP less than 15 mg/dL. This rate was only 64 % for high-risk patients with a mean CRP greater than 15 mg/dL.
Conclusion
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.
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References
Klastersky J (2004) Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis 39(Suppl 1):S32–S37
Bodey GP, Buckley M, Sathe YS, Freireich EJ (1966) Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64:328–340
Rosenberg PS, Alter BP, Bolyard AA, Bonilla MA, Boxer LA, Cham B et al (2006) The incidence of leukemia and mortality from sepsis in patients with severe congenital neutropenia receiving long-term G-CSF therapy. Blood 107:4628–4635
Ramphal R (2004) Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. Clin Infect Dis 39(Suppl 1):S25–S31
Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R et al (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 18:3038–3051
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA et al (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:427–431
Ahn S, Lee YS, Chun YH, Kwon IH, Kim W, Lim KS et al (2011) Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia. Support Care Cancer 19:1151–1158
Hui EP, Leung LK, Poon TC, Mo F, Chan VT, Ma AT et al (2011) Prediction of outcome in cancer patients with febrile neutropenia: a prospective validation of the Multinational Association for Supportive Care in Cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network. Support Care Cancer 19:1625–1635
Ahn S, Lee YS, Lim KS, Lee JL (2013) Adding procalcitonin to the MASCC risk index score could improve risk stratification of patients with febrile neutropenia. Support Care Cancer 21:2303–2308
Elligsen M, Walker SA, Walker SE, LePiane F, Lathia N, De’Angelis C et al (2012) Comparison of mortality between nosocomial and community-acquired febrile neutropenia patients treated initially with cefazolin plus tobramycin: retrospective chart review. Eur J Clin Microbiol Infect Dis 31:1141–1150
Paesmans M, Klastersky J, Maertens J, Georgala A, Muanza F, Aoun M et al (2011) Predicting febrile neutropenic patients at low risk using the MASCC score: does bacteremia matter? Support Care Cancer 19:1001–1008
Nakagawa Y, Suzuki K, Masaoka T (2009) Evaluation of the risk factors for febrile neutropenia associated with hematological malignancy. J Infect Chemother 15:174–179
Baskaran ND, Gan GG, Adeeba K (2008) Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol 87:563–569
Haeusler GM, Carlesse F, Phillips RS (2013) An updated systematic review and meta-analysis of the predictive value of serum biomarkers in the assessment of fever during neutropenia in children with cancer. Pediatr Infect Dis J 32:e390–e396
Lin SG, Hou TY, Huang DH, He SY, Lin YD, Zhang LY et al (2012) Role of procalcitonin in the diagnosis of severe infection in pediatric patients with fever and neutropenia—a systemic review and meta-analysis. Pediatr Infect Dis J 31(10):e182–e188
Phillips RS, Wade R, Lehrnbecher T, Stewart LA, Sutton AJ (2012) Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer. BMC Med 10:6
Miedema KG, de Bont ES, Elferink RF, van Vliet MJ, Nijhuis CS, Kamps WA et al (2011) The diagnostic value of CRP, IL-8, PCT, and sTREM-1 in the detection of bacterial infections in pediatric oncology patients with febrile neutropenia. Support Care Cancer 19:1593–1600
Schuttrumpf S, Binder L, Hagemann T, Berkovic D, Trumper L, Binder C (2006) Utility of procalcitonin concentration in the evaluation of patients with malignant diseases and elevated C-reactive protein plasma concentrations. Clin Infect Dis 43:468–473
Aznar-Oroval E, Sanchez-Yepes M, Lorente-Alegre P (2010) Valor diagnostico de la procalcitonina, la interleucina 8, la interleucina 6 y la proteína C reactiva en la detección de bacteriemia y fungemia en pacientes con cáncer. Enferm Infecc Microbiol Clin 28:273–277
Ortega M, Rovira M, Almela M (2004) Measurement of C-reactive protein in adults with febrile neutropenia after hematopoietic cell transplantation. Bone Marrow Transplant 33:741–744
Kitanovski L, Jazbec J, Hojker S, Derganc M (2014) Diagnostic accuracy of lipopolysaccharide-binding protein for predicting bacteremia/clinical sepsis in children with febrile neutropenia: comparison with interleukin-6, procalcitonin, and C-reactive protein. Support Care Cancer 22:269–277
Massaro K, Costa S, Leone C (2007) Procalcitonin (PCT) and C-reactive protein (CRP) as severe systemic infection markers in febrile neutropenic adults. BMC Infect Dis 7:137
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Combariza, J.F., Lombana, M., Pino, L.E. et al. C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms. Support Care Cancer 23, 1009–1013 (2015). https://doi.org/10.1007/s00520-014-2454-2
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DOI: https://doi.org/10.1007/s00520-014-2454-2