Evaluation of the Multinational Association for Supportive Care in Cancer (MASCC) Score for Identifying Low Risk Febrile Neutropaenic Patients at a South Indian Tertiary Care Centre
Dr Mridula Laxman Bengre
Senior Resident, Department of Internal Medicine,
Kasturba Medical College, Light House Hill Road,
Background: Febrile neutropaenia prompts immediate hospitalization for its evaluation and the administration of empiric broad-spectrum antibiotics. It represents a major cause of morbidity, mortality and treatment costs in patients who receive chemotherapy. Risk stratification to identify the low risk patients is essential, as these patients may improve with outpatient treatment. This approach reduces the economic burden and thereby improves the quality of life.
Objective: Evaluation of the Multinational Association for Supportive Care in Cancer (MASCC) score and also other factors for identifying the low risk febrile neutropaenic patients at a south Indian tertiary care centre.
Materials and Methods: This is a prospective study which was done at a tertiary care hospital in Mangalore, from December 2009 to July 2011. The inclusion criteria were the histological diagnosis of malignancy, neutropaenia which was secondary to chemotherapy, an absolute neutrophil count of < 500/cumm3, oral temperature of >38.30C or >38 0C for 1 hour and age > 13 years. The patients were stratified, based on the MASCC score. Other clinical laboratory parameters were explored for identifying the low risk patients.
Results: A total of 50 cases of febrile neutropaenia were documented; 13 in solid cancers and 37 in haematological cancers. Acute leukaemia was the commonest underlying malignancy (26 out of 50). Seventeen cases were clinically documented, 16 cases were microbiologically documented and in 17 cases, no cause was found. Bacteraemia was the commonest (8 out of 16) among the MDI and E coli was the commonest organism which was identified (5 cases). All the patients were classified, based on the MASCC score. The association of the MASCC score and its outcome in terms of the recovery of the counts were found to be statistically significant (p <0.001). Other factors which were found to be statistically significant in identifying the risk of complications were; tachypnea rate> 24/minutes (p <0.001), Temperature>1020F (p= 0.049), hypotension (BP) value of <90/60 (p<0.001), ANC< 50/Cumm3 (p <0.001), deranged renal parameters (p=0.05), bacteraemia (p=0.001) and the inpatient status (p=0.006).
Conclusions: The MASCC score correctly identifies patients with low risk febrile neutropaenia.