Development and Validation of a Prognostic Risk Score for Patients With Cancer and Neutropenic Fever Presenting to...

Area of Science:

• Oncology
• Emergency Medicine
• Clinical Risk Stratification

Background:

• Neutropenic fever (NF) is a critical oncologic emergency with high morbidity and mortality.
• Existing risk scores for NF lack objectivity, are outdated, and have limited use in the emergency department (ED).

Purpose of the Study:

• To develop and externally validate a pragmatic, objective risk score for predicting adverse outcomes in cancer patients presenting with NF to the ED.

Main Methods:

• A retrospective cohort study utilized data from two major cancer centers for score derivation and external validation.
• The primary composite outcome included ICU admission, bacteremia, oxygen therapy, prolonged hospitalization (>3 days), and in-hospital mortality.
• Predictors were identified and assigned points based on a multivariable logistic regression model.

Main Results:

• The study included 827 patients in the derivation cohort and 777 in the validation cohort.
• The developed risk score achieved an AUC of 0.77 in derivation and 0.78 in validation cohorts, indicating good predictive performance.
• Low-risk patients identified by the score had 0% in-hospital mortality and <2% ICU admission rates across both cohorts.

Conclusions:

• The novel risk score effectively stratifies emergency department patients with neutropenic fever.
• Its objective and readily available data facilitate real-time implementation, potentially improving clinical decisions and reducing hospitalizations.
• Further prospective validation in varied clinical settings is recommended.