Original Research Article
Year: 2022 | Month: July | Volume: 12 | Issue: 7 | Pages: 298-306
DOI: https://doi.org/10.52403/ijhsr.20220742
Evaluation of the Clinical Profile and Application of MASCC Scoring in the Severity Grading of Febrile Neutropenic Patients
Binu Bright1, Aiswarya Ravi2, Dhanasekaran B. S3, Sreekrishnan T.P4
1-4Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, India.
Corresponding Author: Dr. Binu Bright
ABSTRACT
Background: Febrile neutropenia is a major cause of mortality and morbidity in patients on chemotherapy for malignancy. [1][2] It is an oncologic emergency which requires prompt recognition, diagnosis and treatment. It is defined as the single body temperature (oral temperature) of > 38° C (101°F) or an oral temperature of ≥ 38.3◦C persisting for more than 1 hours with an absolute neutrophil count (ANC) of < 1500 cells/mm³. The Multinational Association for Supportive Care Cancer Risk Index is an internationally validated scoring system, published in the year 2000, identifies the low-risk patients to develop serious complications, who can potentially be treated as out patients with oral antibiotics. [3] [5] [6] The score quantifies the risk of FN-related complications by incorporating the patient and cancer characteristics, giving a maximum score of 26. Score more than 20 points is considered as low risk compared to those with less than or equal to 20 points with high risk for serious FN-related complications.
Methods: This is a prospective observational study conducted on 100 patients presenting to Amrita Institute of Medical Sciences (AIMS), Kochi, with Febrile Neutropenia. MASCC Risk Index Score was used to stratify patients into low-risk and high-risk groups. Blood culture and sensitivity were done for all patients apart from all relevant specific investigations.
Results: Out of 100 patients included in the study, 51 were males. FN incidence was more in the age group between 46 and 60. MASCC Risk Index Scoring was used to calculate the level of risk. 60 patients were belonging to low-risk category. Incidence of FN was more in Haematological malignancies, especially in Acute Myeloid Leukaemia. Only 32 patients were found to be having positive blood culture – most of them being found to have Gram-negative bacteria. Appropriate IV antibiotics were used for the initial treatment of the culture positive patients apart from other supportive measures. [8] Regarding patient disposal, 34 patients needed ICU care and 55 were treated in the ward. 11 patients expired - the mortality being more in culture positive patients with one or more associated co morbidities.
Conclusions: We analysed that episodes of FN were common in the middle-aged population. The MASCC score identified patients with febrile neutropenic episodes as elevated risk and low risk. [4] [7] Gram-negative bacteraemia is the predominant cause of febrile neutropenia in our setup.
Key words: [MASCC, Febrile Neutropenia, Malignancy, Chemotherapy, Emergency].