PCT Just as Effective as MASCC for Predicting Serious Complications in Febrile Neutropenia

A single measurement of procalcitonin (PCT) is comparable to Multinational Association for Supportive Care in Cancer (MASCC) score for predicting serious medical complications in patients with cancer with febrile neutropenia, according to a recent study, which concluded that the single measurement can be a useful tool for risk stratification.

MASCC is the most widely used model to risk stratify patients with febrile neutropenia and identify patients who are low risk. Being able to quickly risk stratify patients is crucial as neutropenia predisposes patients to infection and related serious complications, and being able to identify low-risk patients is essential for avoiding overtreatment and unnecessary hospital admissions. The MASCC risk index score is based on 7 independent predictive factors that can be assessed at the onset of fever.

However, the model has limitations, with 2 components being subjective: burden of disease and presence of dehydration requiring intravenous fluids. The researchers add that the model’s ability to predict serious complications is not optimal because they occur in 9% to 15% of patient stratified as low-risk.

“Since the infectious etiology is the main cause of complications in cancer patients with febrile neutropenia, several studies have evaluated the role of infection biomarkers, such as PCT, to improve the performance of MASCC score for risk-stratification or have included it in new prognostic models,” they wrote.

To evaluate the value of PCT and lipopolysaccharide binding protein (LBP), which has a diagnostic accuracy for infection comparable to PCT, as predictors of serious complications and bacteremia, the researchers collected data from 111 episodes of febrile neutropenia in 102 patients admitted to the emergency department between November 2012 and June 2014.

Most of the episodes (78%) were classified as being low-risk for complications with a MASCC score of 21 or higher. The researchers observed infection in 57 episodes, with the most common sources of infection being urinary (35%) and respiratory tracts (26%). There were serious complications in 20 episodes, including 10 deaths, and there were 16 positive blood cultures, 14 by gram-negative bacteria. According to the researchers, serious complications were more common in bacteremia episodes (43.8% vs 13.7%).

‘Regarding to the performance of MASCC score and biomarker levels as predictor tools, MASCC score and PCT concentrations, measured at presentation to the emergency department, showed a similar and good ability to predict the development of serious complications,” explained the researchers. However, the ability was lower for LBP.

Notably, the combination of MASCC score and PCT did not improve the performance compared with each variable alone. For bacteremia episodes, PCT had the highest predictive value.

Reference

Guadiana-Romualdo L, Cerezuela-Fuentes P, Español-Morales, et al. Prognostic value of procalcitonin and lipopolysaccharide binding protein in cancer patients with chemotherapy-assocaited febrile neutropenia presenting to an emergency department [published online December 15, 2018]. Biochem Med. doi: 10.11613/BM.2019.010702.