Clinical Profile, Outcome and Application of MASCC Scoring in Febrile Neutropenic Patients

Background: Febrile neutropenia(FN) is a medical emergency and is a major cause of mortality and morbidity in patients on chemotherapy. MASCC score classifies FN to low and high risk. Methods: A prospective, observational cohort study of consecutive febrile neutropenia episodes were conducted in the Department of Medical oncology, Ramaiah medical college and hospital, Bengaluru, from (October 2014– September 2016). The inclusion criteria were confirmed malignancy and febrile neutropenia secondary to chemotherapy. The neutropenic episodes were stratified into high and minimal risk on MASCC score. Clinical, hematological and biochemical laboratory parameters were collected and compared with low and high MASCC score. Results: Hundred febrile neutropenia episodes were recorded; 85 in solid cancers and 15 in haematological cancers. Breast cancer was the most common cancer (27 out of 100) and E. coli was the major organism which was cultured (9 cases). The association of the MASCC score and the duration of absolute neutrophil count recovery were found to be statistically significant (p<0.001). Presence of medical comorbidities also predicted poor outcome. High grade fever, fever >7 days, tachypnea, hypotension, renal failure, culture positivity, MASCC <21, ANC <50 cells, febrile neutropenia episodes in admitted patients predicted poor outcome (p=0.001). Conclusion: The MASCC score identified patients with febrile neutropenic episodes into elevated risk and low risk. Gram negative bacteremia is the predominant cause of febrile neutropenia in our setup. Individual centers must monitor epidemiology of infections to formulate appropriate antibiotic policy.