Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors

• A. Carmona-Bayonas ^[1] ; P. Jiménez-Fonseca ^[2] ; J. Virizuela ^[3] ; M. Antonio ^[17] ; C. Font ^[4] ; M. Biosca ^[5] ; A. Ramchandani ^[6] ; J. Martinez-Garcia ^[18] ; J. Hernando ^[7] ; J. Espinosa ^[8] ; E. M. de Castro ^[9] ; I. Ghanem ^[10] ; C. Beato ^[11] ; A. Blasco ^[12] ; M. Garrido ^[19] ; R. Mondéjar ^[13] ; M. Á. Arcusa ^[20] ; I. Aragón ^[14] ; A. Manzano ^[11] ; E. Sevillano ^[15] ; E. Castañón ^[16] ; F. Ayala ^[21]
  1. [1] Hospital Morales Meseguer

     Hospital Morales Meseguer

     Murcia, España

     
  2. [2] Hospital Universitario Central de Asturias

     Hospital Universitario Central de Asturias

     Oviedo, España

     
  3. [3] Hospital Universitario Virgen Macarena

     Hospital Universitario Virgen Macarena

     Sevilla, España

     
  4. [4] Hospital Clinic Barcelona

     Hospital Clinic Barcelona

     Barcelona, España

     
  5. [5] Hospital Vall d'Hebron

     Hospital Vall d'Hebron

     Barcelona, España

     
  6. [6] Complejo Hospitalario Universitario Insular - Materno Infantil de Canarias

     Complejo Hospitalario Universitario Insular - Materno Infantil de Canarias

     Gran Canaria, España

     
  7. [7] Hospital Miguel Servet

     Hospital Miguel Servet

     Zaragoza, España

     
  8. [8] Hospital General de Ciudad Real

     Hospital General de Ciudad Real

     Ciudad Real, España

     
  9. [9] Hospital Universitario Marqués de Valdecilla

     Hospital Universitario Marqués de Valdecilla

     Santander, España

     
  10. [10] Hospital Universitario La Paz

      Hospital Universitario La Paz

      Madrid, España

      
  11. [11] Hospital Clínico San Carlos de Madrid

      Hospital Clínico San Carlos de Madrid

      Madrid, España

      
  12. [12] Hospital General Universitario de Valencia

      Hospital General Universitario de Valencia

      Valencia, España

      
  13. [13] Hospital Universitario de la Princesa

      Hospital Universitario de la Princesa

      Madrid, España

      
  14. [14] Hospital Juan Ramón Jiménez

      Hospital Juan Ramón Jiménez

      Huelva, España

      
  15. [15] Hospital Universitario Son Espases

      Hospital Universitario Son Espases

      Palma de Mallorca, España

      
  16. [16] Clínica Universitaria de Navarra

      Clínica Universitaria de Navarra

      Pamplona, España

      
  17. [17] ICO Duran i Reynals (España)
  18. [18] Hospital Universitario Virgen de la Arrixaca, España
  19. [19] Universidad Católica Pontificia de Chile, Chile
  20. [20] Consorci Sanitari de Terrassa, España
  21. [21] Hospital Universitario Morales Messeguer, España

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 19, Nº. 3 (March 2017), 2017, págs. 386-395
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Dialnet Métricas: 1 Cita
• Resumen

  • Purpose The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients.

    Methods We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots.

    Results 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7–14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes.

    Conclusion Despite FN’s clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.