Kanter Efe, Güler Ecem Ermete, Kırık Süleyman, Şahan Tutku Duman, Baygın Melisa Buse, Altınöz Emine, Bora Ejder Saylav, Karakaya Zeynep
Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey.
Department of Emergency Medicine, Cesme Alper Cizgenakat State Hospital, 35930 Izmir, Turkey.
Diagnostics (Basel). 2025 Jul 31;15(15):1922. doi: 10.3390/diagnostics15151922.
: Febrile neutropenia is a common oncologic emergency with significant morbidity and mortality. Although the MASCC (Multinational Association for Supportive Care in Cancer) score is widely used for risk stratification, its limited sensitivity and lack of laboratory parameters reduce its prognostic utility. This study aimed to evaluate whether incorporating serum lactate and CRP measurements into the MASCC score enhances its predictive performance for hospital admission and the 30-day mortality. : This retrospective diagnostic accuracy study included adult patients diagnosed with febrile neutropenia in the emergency department of a tertiary care hospital between January 2021 and December 2024. The original MASCC score was calculated, and three modified models were derived: the MASCC-L (lactate/MASCC), MASCC-C (CRP/MASCC) and MASCC-LC models (CRP × lactate/MASCC). The predictive accuracy for hospital admission and the 30-day all-cause mortality was assessed using ROC analysis. : A total of 269 patients (mean age: 67.6 ± 12.4 years) were included; the 30-day mortality was 3.0%. The MASCC-LC model demonstrated the highest discriminative ability for mortality prediction (area under the curve (AUC): 0.995; sensitivity: 100%; specificity: 98%). For hospital admission prediction, the MASCC-C model had the highest specificity (81%), while the MASCC-LC model showed the best balance of sensitivity and specificity (both 73%). All the modified models outperformed the original MASCC score regarding both endpoints. : Integrating lactate and CRP measurements into the MASCC score significantly improves its prognostic accuracy for both mortality and hospital admission in febrile neutropenic patients. The MASCC-LC model, relying on only three objective parameters, may serve as a practical and efficient tool for early risk stratification in emergency settings.
发热性中性粒细胞减少是一种常见的肿瘤急症，具有较高的发病率和死亡率。尽管多国癌症支持治疗协会（MASCC）评分被广泛用于风险分层，但其有限的敏感性和缺乏实验室参数降低了其预后效用。本研究旨在评估将血清乳酸和CRP测量纳入MASCC评分是否能提高其对住院和30天死亡率的预测性能。：这项回顾性诊断准确性研究纳入了2021年1月至2024年12月在一家三级护理医院急诊科被诊断为发热性中性粒细胞减少的成年患者。计算原始的MASCC评分，并推导了三个改良模型：MASCC-L（乳酸/MASCC）、MASCC-C（CRP/MASCC）和MASCC-LC模型（CRP×乳酸/MASCC）。使用ROC分析评估住院和30天全因死亡率的预测准确性。：共纳入269例患者（平均年龄：67.6±12.4岁）；30天死亡率为3.0%。MASCC-LC模型在死亡率预测方面表现出最高的判别能力（曲线下面积（AUC）：0.995；敏感性：100%；特异性：98%）。对于住院预测，MASCC-C模型具有最高的特异性（81%），而MASCC-LC模型在敏感性和特异性之间表现出最佳平衡（均为73%）。在两个终点方面，所有改良模型均优于原始的MASCC评分。：将乳酸和CRP测量纳入MASCC评分可显著提高其对发热性中性粒细胞减少患者死亡率和住院的预后准确性。仅依赖三个客观参数的MASCC-LC模型可作为急诊环境中早期风险分层的实用且高效工具。
