Applying Multinational Association of Supportive Care of Cancer Index Score for Identifying Febrile Neutropenia Patients at High Risk of Complications at Tertiary Care Hospital, Pakistan

Introduction: Multinational Association of Supportive Care of Cancer (MASCC) index score is a clinical tool to predict outcomes in Febrile Neutropenia patients. This risk-index score has been authenticated in international trials however local data is deficient. We aimed to determine hospital based incidence rate of serious complications in admitted chemotherapy induced febrile neutropenia patients presenting to a tertiary care hospital. We also aimed to compare proportions of serious medical complications in patients having MASCC score <21 or ≥21. Methods: A hospital based prospective close cohort study was designed and conducted at Oncology wards of The Aga Khan University from February to August 2014. Total of 88 patients, aged 16 and above, with chemotherapy induced febrile neutropenia were identified and divided on the basis of MASCC Score into low or high risk {exposure} groups. Follow up was done from day of admission (day zero) to discharge. Outcome was assessed in terms of development of serious complications. Hospital based incidence rate was estimated. The associations between outcome and qualitative variables were evaluated by using Pearson Chi-square and Fisher’s exact test. Results: Hospital based incidence rate of febrile neutropenia admission was 5.98%, 95%CI [4.88% - 7.08%]. Out of 88 patients with chemotherapy induced febrile neutropenia 85.2% patients were in the high risk group and 14.8% in the low risk group. Serious complications were found in 21.33% and no patients in high and low risk group respectively. Age > 60 (p = 0.039), MASCC score < 15 (p = 0.002) and an albumin < 2.5 mg/dl (p = 0.046) was associated with higher chance of developing serious complications. Sensitivity, specificity, positive and negative predictive value of MASCC score in predicting risk of serious complications was 21.33%, 100%, 100% and 18.06% respectively. Conclusion: MASCC risk-index score is a useful tool to identify patients at low risk of complications. Hospital based incidence rate of serious complications was 18.2%.