Innes Helen, Lim Sheow Lei, Hall Allison, Chan Su Yin, Bhalla Neeraj, Marshall Ernest
Clatterbridge Centre for Oncology NHS Foundation Trust, Bebington, Wirral Merseyside, CH63 4JY, UK.
Support Care Cancer. 2008 May;16(5):485-91. doi: 10.1007/s00520-007-0334-8. Epub 2007 Sep 25.
Febrile neutropenia (FN) represents a spectrum of severity in which low-risk patients can be defined using the Multinational Association for Supportive Care in Cancer (MASCC) risk index. However, despite publication in 2000, there remains limited published literature to date to support the use of MASCC risk assessment in routine clinical practice and eligibility for early hospital discharge. In this study, we present our experience with the routine use of the MASCC risk index to determine the management of FN in our institution.
Patients treated for solid tumours or lymphomas with low-risk FN (MASCC score >/ or =21) were eligible for oral antibiotics (ciprofloxacin plus either co-amoxiclav or doxycycline) and for early hospital discharge irrespective of first or subsequent episode. The primary outcome was rate of resolution of FN without serious medical complications (SMC). Secondary outcomes were the "success" of antibiotic therapy without treatment modifications, duration of hospitalisation and rate of readmissions.
A total of 100 FN episodes occurring in 83 patients were treated over a 6-month period. Ninety of these episodes were low-risk (90%), of which 75 received oral antibiotics (83.3%) and 3 (3.3%) experienced SMC, and the success rate was 94.5% [95% confidence interval (CI) 89.6-99.3%] in low-risk episodes. The median duration of hospitalisation was 2.5 days (25th centile: 1.0 day; 75th centile: 5.0 days) in low-risk compared to 6.5 days (25th centile: 5.3 days; 75th centile: 9.3 days) in high-risk episodes (p = 0.003); 2 days for low-risk episodes treated with oral antibiotics compared to 4 days for low-risk receiving intravenous antibiotics (p = 0.015). Positive predictive value for the MASCC index was 96.7% (95% CI 95.0-98.6%).
The MASCC risk index is both feasible and safe when used in standard clinical practice to guide the management of FN in patients with solid tumours and lymphomas. Patients predicted to have low risk can be managed safely with oral antibiotics and early hospital discharge.
发热性中性粒细胞减少症（FN）存在一系列严重程度，其中低风险患者可通过癌症支持治疗多国协会（MASCC）风险指数来定义。然而，尽管该指数于2000年发布，但迄今为止，支持在常规临床实践中使用MASCC风险评估及早期出院资格的已发表文献仍然有限。在本研究中，我们介绍了在我们机构中常规使用MASCC风险指数来确定FN管理的经验。
患有低风险FN（MASCC评分≥21）的实体瘤或淋巴瘤患者，无论首次或后续发作，均有资格接受口服抗生素治疗（环丙沙星加阿莫西林克拉维酸钾或强力霉素）并早期出院。主要结局是FN缓解且无严重医学并发症（SMC）的发生率。次要结局是无需调整治疗的抗生素治疗“成功率”、住院时间和再入院率。
在6个月期间，共治疗了83例患者的100次FN发作。其中90次发作属于低风险（90%），其中75例接受了口服抗生素治疗（83.3%），3例（3.3%）发生了SMC，低风险发作的成功率为94.5%[95%置信区间（CI）89.6 - 99.3%]。低风险发作的中位住院时间为2.5天（第25百分位数：1.0天；第75百分位数：5.0天），而高风险发作的中位住院时间为6.5天（第25百分位数：5.3天；第75百分位数：9.3天）（p = 0.003）；接受口服抗生素治疗的低风险发作住院2天，而接受静脉抗生素治疗的低风险发作住院4天（p = 0.015）。MASCC指数的阳性预测值为96.7%（95% CI 95.0 - 98.6%）。
在标准临床实践中使用MASCC风险指数来指导实体瘤和淋巴瘤患者的FN管理既可行又安全。预计为低风险的患者可以通过口服抗生素和早期出院进行安全管理。
