MASCC Score For Febrile Neutropenia Calculator

How does this MASCC score for febrile neutropenia calculator work?

This is a health tool based on the Evaluation of the Multinational Association for Supportive Care in Cancer (MASCC) Score for Identifying Low Risk Febrile Neutropaenic Patients.

There are 8 variables accounted for in the model, each with a different set of points, for some awarded if the criterion is present while for others, if the criterion is absent:

■ Age as a risk factor, with a cut off of 60 years old, patients below 60 receive 2 points.

■ The onset of fever is regarded as important with outpatient fever receiving 3 points.

■ In terms of symptoms, None or Mild receive 5 points, Moderate weighs 3 points while Severe or Moribund are not given any points.

■ Systolic Blood Pressure ≤90 mmHg is given 0 points, while values >90 mmHg receive 5 points.

■ Active COPD defined as Active chronic bronchitis, emphysema, decrease in forced expiratory volumes, and need for oxygen and corticosteroids therapy with or without bronchodilators. Negative answer is awarded 4 points.

■ Solid tumor positive answer equals 2 points.

■ No previous fungal infection in patient with a hematologic malignancy is awarded 2 points.

■ Dehydration requiring parental fluids is the last criterion, which if negative, adds 3 more points to the total score.

In terms of psychometric properties, this cancer score has a positive predictive value of 91%, a specificity of 68% and a sensitivity of 71% in determining patients that are at low risk of developing complications.

There are other risk tools in usage such as the Clinical Index of Stable Febrile Neutropenia (CISNE) score, however, this one is specialized for patients with solid tumors.

The CISNE however is able to discriminate between 3 levels of risk: low, intermediate and high while the MASCC only exhibits two.

MASCC score interpretation

The 8 criteria described above have an intricate scoring system with points that are awarded depending on how low risk the presence of that criterion is for the patient, rather than the usual way which tries to stratify towards high risk.

The maximum theoretical score is 26 while the lowest is 0.

This means that in the MASCC score calculator, the higher the result, the more positive the outcome. The 2 guidelines around the cut off of 21 points are exemplified below:

■ MASCC ≥21 is indicative of a low risk of febrile neutropenia. Recommended management is as outpatient with oral abx. Patients deemed low risk have a 91% chance of condition resolution without complications.

■ MASCC <21 is indicative of a high risk of febrile neutropenia. Recommended treatment is inpatient with IV antibiotics. Patients deemed high risk have a 64% chance of condition resolution without complications.

Febrile neutropenia guidelines

This condition is viewed as a febrile complication of myelosuppressive chemotherapy and considered a medical emergency. Consistent with infection, there is a low number of neutrophil granulocyte, bacteremia and sometimes the term neutropenic sepsis is used.

There are several associated complications, which include:

■ hypotension;

■ risk of hemorrhage;

■ cardiac complications;

■ respiratory failure;

■ renal failure;

■ confusion;

■ intensive care unit admission;

■ death.

Given the gravity of the condition, such a risk stratification tool allows prophylaxis or quick intervention with the classic treatment of broad-spectrum antibiotics administered intravenously.

References

1) Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J. (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(16):3038-51.

2) Klastersky J, Paesmans M. (2013) The Multinational Association for Supportive Care in Cancer (MASCC) risk index score: 10 years of use for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer; 21(5):1487-95.

3) Talcott JA, Finberg R, Mayer RJ, Goldman L. (1988) The medical course of cancer patients with fever and neutropenia. Clinical identification of a low-risk subgroup at presentation. Arch Intern Med; 148(12):2561-8.

4) Carmona-Bayonas A, Gómez J, González-Billalabeitia E, Canteras M, Navarrete A, Gonzálvez ML, Vicente V, Ayala de la Peña F. (2011) Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients. Br J Cancer; 105(5):612-7.

5) de Naurois J, Novitzky-Basso I et al. Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Oxford Journals Medicine & Health Annals of Oncology V21, IS 5Pp. v252-v256.