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The MASCC scoring system for febrile neutropenia is a tool that calculates a numerical score to help estimate the risk of serious complications in patients based on seven key clinical criteria. Each criterion is associated with specific conditions that contribute a designated number of points to the overall score. Below is a concise explanation of how each criterion can affect the scoring:

- Burden of Illness:
  - None or mild symptoms score 5 points.
  - Moderate symptoms score 3 points.
  - Severe symptoms score 0 points.

- Hypotension (systolic blood pressure < 90 mmHg):
  - No hypotension grants 5 points.
  - Presence of hypotension scores 0 points.

- Active Chronic Obstructive Pulmonary Disease (COPD):
  - Absence of COPD gains 4 points.
  - Presence of COPD scores 0 points.

- Type of Cancer:
  - Patients with a solid tumor score 4 points.
  - Hematologic cancer without prior fungal infection scores 4 points.
  - Hematologic cancer with prior fungal infection scores 0 points.

- Dehydration requiring IV fluids:
  - Lack of dehydration grants 3 points.
  - Dehydration scores 0 points.

- Status at Fever Onset:
  - Being an outpatient scores 3 points.
  - Being an inpatient scores 0 points.

- Age, years:
  - Patients younger than 60 score 2 points.
  - Patients aged 60 or older score 0 points.

The total score is the sum of points from these criteria, providing a range between 0 and 26. This total determines the patient's interpretation of risk:

- A score of 21 or more suggests that the risk of serious complications is low.
- Any score below 21 indicates a high risk of serious complications. 

This systematic scoring aids clinicians in making informed decisions about the treatment and management of patients with febrile neutropenia.

The MASCC Score, or Multinational Association for Supportive Care in Cancer Score, is a clinical calculator used in the management of patients with febrile neutropenia, a common complication in cancer patients undergoing chemotherapy. This scoring system is used to identify low-risk patients who are likely to have a better prognosis and may be candidates for outpatient management. The MASCC Score takes into account factors such as age, history of chronic obstructive pulmonary disease, history of fungal infection, blood pressure, and symptoms like fatigue, dehydration, and oral mucositis. Patients with a MASCC score of 21 or higher are considered low-risk. The calculator should not be used in patients with severe sepsis or septic shock, or in those with other serious medical conditions that require hospitalization.

MASCC score for febrile neutropenia

The febrile neutropenia diagnostic tool assesses whether a patient meets the criteria for febrile neutropenia based on their fever and neutrophil count levels. This requires two specific determinations from the user:

1. Fever:
   - A single oral temperature reading of 38.3°C (101°F) or higher.
   - A temperature of at least 38.0°C (100.4°F) sustained over a period of one hour.

2. Neutropenia:
   - An absolute neutrophil count (ANC) of 500/microliter (mcL) or less.
   - An ANC expected to drop below 500/mcL within the subsequent 48 hours.

The diagnostic process evaluates these criteria as follows:

- For fever, if either criterion is satisfied (a single high measurement or sustained elevated temperature), the fever condition is considered met.
- For neutropenia, if either criterion is met (ANC already low or anticipated to become low), the neutropenia condition is satisfied.

Febrile neutropenia is diagnosed when both a fever condition and a neutropenia condition are present. The diagnostic tool then provides the outcome:

- If both a fever condition and a neutropenia condition are present simultaneously, the patient meets the criteria for febrile neutropenia.
- If one or neither condition is met, the diagnostic criteria are not satisfied.

The diagnostic assessment outlined through user inputs ensures a straightforward determination of whether the criteria for febrile neutropenia are fulfilled. Here's a simplified overview of the possible outcomes:

| Fever Condition                           | Neutropenia Condition                                             | Result                                  |
|-------------------------------------------|-------------------------------------------------------------------|-----------------------------------------|
| Fever >= 38.3°C (101°F) or sustained ≥ 38.0°C (100.4°F) for 1 hour | Neutrophil count <= 500/mcL or expected to decrease to < 500/mcL  | Meets criteria for febrile neutropenia  |
| Any other situation                       | Any other situation                                               | Diagnostic criteria not met             |

This tool systematically assesses input parameters to help healthcare providers determine the presence of a potential febrile neutropenia case based on standard diagnostic measures.

The calculator in question is the Diagnostic Criteria for Febrile Neutropenia. This is a clinical tool used primarily in the field of oncology and hematology, specifically for patients undergoing chemotherapy or other treatments that may suppress the immune system. 

Febrile neutropenia is a serious complication of chemotherapy characterized by a fever and a reduced number of neutrophils, a type of white blood cell that fights infection. The diagnostic criteria for febrile neutropenia are typically defined as a single oral temperature of ≥38.3°C (≥101°F) or a temperature of ≥38.0°C (≥100.4°F) sustained over a 1-hour period, along with a neutrophil count of <500 cells/mm³ or expected to fall below 500 cells/mm³ within the next 48 hours.

The clinical utility of this calculator is to help clinicians identify patients who are at risk of developing serious infections due to their low neutrophil count and fever. Early identification of febrile neutropenia can lead to prompt initiation of antibiotic therapy, which can significantly improve patient outcomes.

There are no specific exclusion criteria for the use of this diagnostic criteria. However, it is primarily applicable to patients undergoing treatments that suppress the immune system,

Diagnostic criteria for febrile neutropenia

The Clinical Index of Stable Febrile Neutropenia (CISNE) calculator is designed to estimate the risk of severe complications in patients experiencing febrile neutropenia. This risk assessment involves considering six specific clinical variables. By assigning numerical values to each variable based on certain clinical criteria, the calculator derives a total score that indicates the severity level of potential complications.

Here's how the scoring for each input variable works:

- ECOG Performance Status: 
  - If the status is "< 2", it scores 0.
  - If the status is ">= 2", it scores 2.

- Stress-induced hyperglycemia:
  - "Yes" results in a score of 2.
  - "No" results in a score of 0.

- COPD (Chronic Obstructive Pulmonary Disease):
  - "Yes" contributes 1 to the score.
  - "No" contributes 0.

- Chronic Cardiovascular Disease:
  - "Yes" scores 1.
  - "No" scores 0.

- Mucositis NCI grade:
  - A grade of ">= 2" scores 1.
  - Less than this scores 0.

- Monocytes count:
  - "> 200/mcL" scores 0.
  - "< 200/mcL" scores 1.

To determine the total CISNE score, sum up the values assigned to each of these inputs. Based on this total score, the patient's risk of severe complications is interpreted as follows:

- A score of 0 indicates a minimal risk, with the chance of severe complications being approximately 1.1%.
- Scores of 1 or 2 suggest a moderate risk, with a 6.2% chance of severe complications.
- Scores of 3 or more represent a high risk, where the probability of severe complications substantially increases to 36%.

This straightforward scoring system allows healthcare providers to quickly assess the severity of a patient's condition and make informed decisions regarding their care.

The Clinical Index of Stable Febrile Neutropenia (CISNE) is a risk stratification tool used in the management of adult cancer patients with chemotherapy-induced febrile neutropenia. This calculator is designed to identify low-risk patients who may be suitable for outpatient management or early hospital discharge. The CISNE score is based on seven clinical variables including burden of chronic illness, stress-induced hyperglycemia, and systolic blood pressure. It is not recommended for use in patients with severe sepsis or septic shock, or in those with rapidly progressive or life-threatening conditions.

Febrile neutropenia

Background

Overview

Guidelines

Key sources