This nomogram was developed between 2012 and 2014 in 1133 adult patients with seemingly stable febrile neutropenia from 25 hospitals (mean age 58, 54% male, 13% serious complication rate).
The scope of the model’s applicability must always be confirmed and attention must be paid to unusual risk factors that may be important in a minority of patients. The CISNE score should not be used to select low risk patients who are eligible for outpatient care with oral antibiotics, until a clinical trial can be carried out to confirm the safety of this approach.
Patients should be clinically stable within the first 3 hours after diagnosis of FN. Clinical stability included all of the following: absence of acute organ failure (renal, cardiac, and respiratory) and decompensation of chronic organ insufficiency, absence of septic shock and hypotension (systolic pressure < 90 mm/Hg), no known severe infections, and absence of other serious complications, constituting admission criteria in and of themselves.
Across the 1000 bootstrap replications, this risk calculator sorted patients who developed complications with a bootstrap optimism-corrected c-index of 0.855 (95% CI, 0.823-0.887). The model was well calibrated across all risk levels. The cut-off corresponding to the Youden-index was a predicted probability ≥13% (high-risk). In a separate dataset from the USH registry, the model yielded a c-index of 0.831 (95% CI, 0.782-0.871).
The CISNE model does not rule out the possibility that there may be patients with unusual risk factors who must be taken into consideration. However, the MASCC model has a low sensitivity in this population, even after adjusting the cutoff and, as a result, does not appear to be an optimal method by means of which to select low risk patients in this group. In contrast, the CISNE scale was able to discriminate a group of low, intermediate, and high risk of complications (1%, 6%, and 36%), respectively. Hence, a two-step combination of a set of exclusion criteria plus a validated triage-friendly scale such as CISNE rendered better prognostic stratification than those of the approaches currently used. The results are especially applicable to prevent early discharge of stable patients with a high risk for complications.
Predictions are only orientative, so decisions should be taken at the discretion of the attending physician. However, CISNE could in fact be useful to delay or avoid early discharge of certain seemingly stable patients who begin inpatient treatment until they demonstrate to be truly stable and blood cultures are verified to be negative.
Disclaimer: This tool is intended for use by healthcare professionals only. Patients with febrile neutropenia should seek medical care urgently. Physicians and other healthcare professionals who use CISNE should exercise their own clinical judgment. This app do not give professional advice. We have cautiously tried to create this app based on real-world data. However, standards and practice in medicine mayvary as new information become available and professionals should consult a diversity of medical sources. We tried to provide an estimation of risk for clinically stable patients, but we do not endorse any particular management strategy. In particular we did not developed this tool to reduce the level of supportive care for FN patients, but just for the opposite. Your reliance upon predictions obtained through this app is solely at your own risk. We do not assume any liability or responsibility for damage or injury (including death) to you or other people from any use of this tool.
- Carmona-Bayonas A, Gómez J, González-Billalabeitia E et al. Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients. Br. J. Cancer 2011; 105(5):612–617.
- Carmona-Bayonas, Alberto, Paula Jiménez-Fonseca, Juan Virizuela Echaburu, Maite Antonio, Carme Font, Mercè Biosca AR et al. 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. J. Clin. Oncol. 2015; 33(5):465–471.
- Paula Jiménez Fonseca, Alberto Carmona-Bayonas, Ignacio Matos García, Rosana Marcos Sánchez, Eduardo Castañón, Maite Antonio, Carme Font Puig, Mercè Biosca, Ana Blasco, Rebeca Lozano Mejorada, Avinash Ramchandani, Carmen Beato, Eva Martínez de Castro, Javier Espinosa Arranz, Jerónimo Martínez-García, Ismael Ghanem, Jorge Hernando Cubero, Isabel Aragón Manrique, Francisco García Navalón, Elena Sevillano, Aránzazu Manzano, JA Virizuela, Marcelo Garrido, Rebeca Mondéjar Solís, Maria Angels Arcusa Lanza, Yaiza Bonilla, Quionia Pérez, Elena Gallardo, Maria del Carmen Soriano Rodríguez, Mercè Cardona, Fernando Sánchez Lasheras, Juan Jesus Cruz Hernández, and Francisco Ayala de la Peña. A nomogram for predicting complications in patients with solid tumors and seemingly stable febrile neutropenia. British Journal of Cancer; May (2016), 1–8 | doi: 10.1038/bjc.2016.118.