Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Emerg Med. 2021 May;60(5):641-647. doi: 10.1016/j.jemermed.2020.12.010. Epub 2021 Jan 28.
Various risk-stratification scores have been developed to identify low-risk febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) score is a commonly used validated scoring system, although its performance varies due to its subjectivity. Biomarkers like procalcitonin (PCT) are being used in patients with FN to detect bacteremia and additional complications.
Our objective was to compare the performance of MASCC score with PCT in predicting adverse outcomes in patients with FN.
This was a prospective observational study that included chemotherapy-induced FN in hematologic or solid malignancy. The MASCC score, PCT levels, and blood cultures were taken at the first point of contact, and patient treatment was managed according to routine institutional protocol. The primary outcome was mortality at 30 days.
A total of 100 patients were recruited, of which 92 had hematologic malignancy and 8 had solid malignancy. Forty-six patients were classified as low risk by MASCC score (≥21). The PCT threshold, 1.42 ng/mL, was taken as a cutoff value, with area under the receiver operating characteristic curve (AUROC) of 0.664 (95% confidence interval [CI] -0.55 to 0.77) for predicting mortality. AUROC for MASCC was 0.586 (95% CI 0.462 to 0.711).
PCT is a useful marker with better prognostic efficacy than MASCC score in patients with FN and can be used as an adjunct to the score in risk-stratifying patients with FN.
已经开发了各种风险分层评分来识别低危发热性中性粒细胞减少症（FN）。多国癌症支持治疗协会（MASCC）评分是一种常用的经过验证的评分系统，但其性能因主观性而有所不同。降钙素原（PCT）等生物标志物正被用于 FN 患者中以检测菌血症和其他并发症。
我们的目的是比较 MASCC 评分与 PCT 在预测 FN 患者不良结局方面的性能。
这是一项前瞻性观察性研究，纳入了血液系统或实体恶性肿瘤引起的化疗诱导性 FN。在首次接触时采集 MASCC 评分、PCT 水平和血培养，并根据常规机构方案管理患者治疗。主要结局是 30 天死亡率。
共招募了 100 例患者，其中 92 例为血液系统恶性肿瘤，8 例为实体恶性肿瘤。46 例患者 MASCC 评分（≥21）被归类为低危。PCT 阈值为 1.42ng/mL，作为截断值，预测死亡率的受试者工作特征曲线下面积（AUROC）为 0.664（95%置信区间 [CI] -0.55 至 0.77）。MASCC 的 AUROC 为 0.586（95%CI 0.462 至 0.711）。
PCT 是一种有用的标志物，在 FN 患者中的预后预测效果优于 MASCC 评分，可以作为 FN 患者风险分层的辅助标志物。
