Criteria

The Talcott system[2]

A risk stratification tool for febrile neutropenia that identifies the following risk groups based on certain clinical characteristics:

  • Group I (inpatient at time of fever onset)

  • Group II (outpatient with concurrent comorbidity requiring hospitalization)

  • Group III (outpatient with uncontrolled cancer)

  • Group IV (outpatient with controlled cancer and without comorbidity).

Patients in group I to III have a significantly higher risk of complication and death associated with febrile neutropenia than patients in group IV (low risk). Patients in group IV may qualify for outpatient management.

The Talcott system has a positive predictive value of 93%, but it misclassifies patients up to 59% of the time.[2]

The Multinational Association of Supportive Care in Cancer (MASCC) score[55]

A risk-index score that identifies patients with febrile neutropenia who are at low or high risk of complications based on the following characteristics:

  • Burden of illness: no or mild symptoms (score: 5); moderate symptoms (score: 3); severe symptoms (score: 0)

  • No hypotension (score: 5)

  • No chronic obstructive pulmonary disease (score: 4)

  • Solid tumor or hematologic malignancy with no previous fungal infection (score: 4)

  • No dehydration requiring intravenous fluids (score: 3)

  • Outpatient status (score: 3)

  • Age <60 years (score: 2).

A total score ≥21 is considered low risk, and a total score <21 is considered high risk.

This MASCC score has a positive predictive value of 98% and misclassifies patients approximately 30% of the time.[55]

The Clinical Index of Stable Febrile Neutropenia (CISNE) score[4]

A risk score model that uses the following 6 criteria to risk-stratify patients with solid tumors and clinically stable febrile neutropenia:

  • Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (2 points)

  • Stress-induced hyperglycemia (2 points)

  • Chronic obstructive pulmonary disease (1 point)

  • Chronic cardiovascular disease (1 point)

  • Mucositis grade ≥2 (1 point)

  • Monocyte count <200/microliter (1 point).

A total score of 0, 1-2, and ≥3 points correlates with low, intermediate, and high risk, respectively.[4]

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