Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

PubMedID: 23519568

Ahn S, Lee YS, Lim KS, Lee JL. Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia. Support Care Cancer. 2013;21(8):2303-8.
PURPOSE
Infectious complication could be life-threatening in patients with chemotherapy-induced febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) risk-index score is used to predict the complications of these patients, and it has been focused on identifying low-risk patients who may be candidates for outpatient management. In this study, we evaluated procalcitonin (PCT) and the MASCC score in predicting bacteremia and septic shock in patients with FN.

METHODS
From November 2010 to October 2011, 355 patients with FN were prospectively enrolled. Clinical and laboratory findings, including procalcitonin, and the MASCC score were analyzed and correlated with the infectious complications of FN.

RESULTS
Of the 355 patients, 35 (9.9 %) had bacteremia, and 25 (7.0 %) developed septic shock. PCT = 0.5 ng/mL (OR 3.96, 95 % CI 1.51-10.40), platelet count <100 × 10(3)/mm(3) (OR 2.50, 95 % CI 1.10-5.66), and MASCC score <21 (OR 2.45, 95 % CI 1.03-5.85) were independently predictive of bacteremia, and PCT = 1.5 ng/mL (OR 29.78, 95 % CI 9.10-97.39) and MASCC score <21 (OR 9.46, 95 % CI 3.23-27.72) were independent factors of septic shock. In 306 patients with low-risk FN classified by the MASCC score, 52 had PCT = 0.5 ng/mL and 31 had PCT = 1.5 ng/mL. Of the 52 patients with PCT = 0.5 ng/mL, 12 (23.1 %) had bacteremia, and of the 31 patients with PCT = 1.5 ng/mL, 7 (22.6 %) developed septic shock.

CONCLUSION
Implicating PCT as a routine use in clinical practice along with the MASCC score could improve risk stratification of patients with FN.