Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia

Infectious complication could be life-threatening in patients with chemotherapy-induced febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) risk-index score is used to predict the complications of these patients, and it has been focused on identifying low-risk patients who may be candidates for outpatient management. In this study, we evaluated procalcitonin (PCT) and the MASCC score in predicting bacteremia and septic shock in patients with FN. From November 2010 to October 2011, 355 patients with FN were prospectively enrolled. Clinical and laboratory findings, including procalcitonin, and the MASCC score were analyzed and correlated with the infectious complications of FN. Of the 355 patients, 35 (9.9 %) had bacteremia, and 25 (7.0 %) developed septic shock. PCT a parts per thousand yen0.5 ng/mL (OR 3.96, 95 % CI 1.51-10.40), platelet count < 100 x 10(3)/mm(3) (OR 2.50, 95 % CI 1.10-5.66), and MASCC score < 21 (OR 2.45, 95 % CI 1.03-5.85) were independently predictive of bacteremia, and PCT a parts per thousand yen1.5 ng/mL (OR 29.78, 95 % CI 9.10-97.39) and MASCC score < 21 (OR 9.46, 95 % CI 3.23-27.72) were independent factors of septic shock. In 306 patients with low-risk FN classified by the MASCC score, 52 had PCT a parts per thousand yen0.5 ng/mL and 31 had PCT a parts per thousand yen1.5 ng/mL. Of the 52 patients with PCT a parts per thousand yen0.5 ng/mL, 12 (23.1 %) had bacteremia, and of the 31 patients with PCT a parts per thousand yen1.5 ng/mL, 7 (22.6 %) developed septic shock. Implicating PCT as a routine use in clinical practice along with the MASCC score could improve risk stratification of patients with FN.