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Development and Validation of a Prognostic Risk Score for Patients With Cancer and Neutropenic Fever Presenting to
Sandy Nath1, Aiham Qdaisat2, Andriy Derkach3
1Emergency Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Summary
A new objective risk score accurately predicts adverse outcomes for patients with neutropenic fever (NF) in the emergency department (ED). This tool aids clinical decision-making and can reduce unnecessary hospitalizations for cancer patients with NF.
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- Existing risk scores for NF lack objectivity, are outdated, and have limited use in the emergency department (ED).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.
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