Clinical Comparison of MASCC and CISNE Scores in Neutropenic Febrile Patients in the Emergency Department

Objective: Febrile neutropenia is an important condition that needs to be well managed in the emergency department. Home treatment and hospitalization requirements of the patients are made according to some risk classifications. The most commonly used MASCC score may involve risks in terms of early discharge. Our aim in this study is to show that these risks can be reduced if the MASCC score is supported by the CISNE score. In addition, it is to determine the contribution of procalcitonin values to these classifications. Material and Method: Neutropenic febrile patients over the age of 18 who came to the emergency department between 2019 and 2020 were included in the study. MASCC and CISNE scores of the patients were calculated. The relationship between scores and mortality was examined. Mortality estimation was made by using MASCC and CISNE scores together. In addition, patients were divided into 4 groups according to their proclacytonin values. The relationship between MASCC, CISNE and mortality between the groups was examined. Results: Of the 103 patients included in the study, 70.9% were male. The most common reason for admission was found to be acute gastroenteritis with 22.3%. 40.8% of the patients died. According to the MASCC score, 35.9% of the patients were found to be at high risk. Despite this, 85.4% of them were hospitalized and treated. There was an inverse, moderate statistically significant correlation with MASCC (r=-0.542, p=0.000), and a weak statistically significant correlation with CISNE (r=0.385, p=0.000). There was a moderately significant correlation between procalcitonin, one of the acute phase indicators, and mortality (r=-0.555, p=0.000). Conclusion: Evaluating neutropenic febrile patients with MASCC score for high-risk patients and CISNE score for low-risk patients in the emergency department gives more accurate results in determining poor prognosis. If these two scores are evaluated together with procalcitonin, the out-of-hospital mortality rate can be further reduced. For this, prospective studies in which risk scores are modified with a marker such as procalcitonin are needed.