Prediction of Serious Complications in Patients With Seemingly Stable Febrile Neutropenia: Validation of the Clinical Index of Stable Febrile Neutropenia in a Prospective Cohort of Patients From the FINITE Study

被引：112

作者：

Carmona-Bayonas, Alberto ^{[1
]}

Jimenez-Fonseca, Paula ^{[3
]}

Virizuela Echaburu, Juan ^{[4
]}

Antonio, Maite ^{[6
]}

Font, Carme ^{[7
]}

Biosca, Merce ^{[8
]}

Ramchandani, Avinash ^{[10
]}

Martinez, Jeronimo ^{[2
]}

Hernando Cubero, Jorge ^{[11
]}

Espinosa, Javier ^{[12
]}

Martinez de Castro, Eva ^{[13
]}

Ghanem, Ismael ^{[14
]}

Beato, Carmen ^{[5
]}

Blasco, Ana ^{[17
]}

Garrido, Marcelo ^{[26
]}

Bonilla, Yaiza ^{[18
]}

Mondejar, Rebeca ^{[15
]}

Arcusa Lanza, Maria Angeles ^{[9
]}

Aragon Manrique, Isabel ^{[19
]}

Manzano, Aranzazu ^{[16
]}

Sevillano, Elena ^{[20
]}

Castanon, Eduardo ^{[21
]}

Cardona, Merce ^{[22
]}

Gallardo Martin, Elena ^{[23
]}

Perez Armillas, Quionia ^{[24
]}

Sanchez Lasheras, Fernando ^{[25
]}

Ayala de la Pena, Francisco ^{[1
]}

机构：

[1] Hosp Univ Morales Meseguer, Murcia, Spain

[2] Hosp Univ Virgen de la Arrixaca, Murcia, Spain

[3] Hosp Univ Cent Asturias, Oviedo, Spain

[4] Hosp Univ Virgen Macarena, Seville, Spain

[5] Hosp Nisa Aljarafe, Seville, Spain

[6] Inst Catala Oncol Duran & Reynals, Barcelona, Spain

[7] Hosp Univ Clin, Barcelona, Spain

[8] Hosp Univ Vall dHebron, Barcelona, Spain

[9] Consorci Sanitari Terrassa, Barcelona, Spain

[10] Hosp Univ Las Palmas, Las Palmas Gran Canaria, Spain

[11] Hosp Univ Miguel Servet, Zaragoza, Spain

[12] Hosp Gen Univ Ciudad Real, Ciudad Real, Spain

[13] Hosp Univ Marques de Valdecilla, Santander, Spain

[14] Hosp Univ La Paz, Madrid, Spain

[15] Hosp Virgen de la Luz de Cuenca, Madrid, Spain

[16] Hosp Univ Clin San Carlos, Madrid, Spain

[17] Hosp Gen Univ Valencia, Valencia, Spain

[18] Hosp Santa Lucia, Cartagena, Spain

[19] Hosp Juan Ramon Jimenez, Huelva, Spain

[20] Hosp Univ Son Espases, Palma De Mallorca, Spain

[21] Univ Navarra Clin, Navarra, Spain

[22] Hosp Tortosa Verge de la Cinta, Tarragona, Spain

[23] Complejo Univ Pontevedra, Pontevedra, Spain

[24] Hosp Univ Valladolid, Valladolid, Spain

[25] Univ Oviedo, Gijon, Spain

[26] Univ Catolica Pontificia Chile, Santiago, Chile

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2015年 / 33卷 / 05期

关键词：

CANCER-PATIENTS; OUTPATIENT MANAGEMENT; ORAL ANTIBIOTICS; FEVER; THERAPY; COST; MORTALITY; SOCIETY;

D O I：

10.1200/JCO.2014.57.2347

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose To validate a prognostic score predicting major complications in patients with solid tumors and seemingly stable episodes of febrile neutropenia (FN). The definition of clinical stability implies the absence of organ dysfunction, abnormalities in vital signs, and major infections. Patients and Methods We developed the Clinical Index of Stable Febrile Neutropenia (CISNE), with six explanatory variables associated with serious complications: Eastern Cooperative Oncology Group performance status 2 (2 points), chronic obstructive pulmonary disease (1 point), chronic cardiovascular disease (1 point), mucositis of grade 2 (National Cancer Institute Common Toxicity Criteria; 1 point), monocytes < 200 per L (1 point), and stress-induced hyperglycemia (2 points). We integrated these factors into a score ranging from 0 to 8, which classifies patients into three prognostic classes: low (0 points), intermediate (1 to 2 points), and high risk ( 3 points). We present a multicenter validation of CISNE. Results We prospectively recruited 1,133 patients with seemingly stable FN from 25 hospitals. Complication rates in the training and validation subsets, respectively, were 1.1% and 1.1% in low-, 6.1% and 6.2% in intermediate-, and 32.5% and 36% in high-risk patients; mortality rates within each class were 0% in low-, 1.6% and 0% in intermediate-, and 4.3% and 3.1% in high-risk patients. Areas under the receiver operating characteristic curves in the validation subset were 0.652 (95% CI, 0.598 to 0.703) for Talcott, 0.721 (95% CI, 0.669 to 0.768) for Multinational Association for Supportive Care in Cancer (MASCC), and 0.868 (95% CI, 0.827 to 0.903) for CISNE (P = .002 for comparison between CISNE and MASCC). Conclusion CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes.

引用

页码：465 / U124

页数：11

共 24 条

[1] Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy [J].