Risk stratification in febrile neutropenic patients

Abstract

Febrile neutropenia is a common complication of antineoplastic chemotherapy, especially in patients with hematologic malignancies. Infection prevention strategies such as chemoprophylaxis or the administration of prophylactic growth factors have not been clearly shown to reduce complications of febrile neutropenia, to be cost-effective, or to have a significant impact on mortality. Since febrile neutropenic patients represent a heterogeneous population, extensive research has been conducted on how to reliably identify a low-risk subset and to develop risk-based treatment strategies for low-risk and non-low-risk subsets. For adult patients, two validated risk prediction models have been developed: the Talcott model and the MASCC risk index. Clinical criteria and the MASCC model have been used successfully to identify patients suitable for treatment with oral antimicrobial regimens, after early discharge from hospital or entirely as outpatients. The primary focus of risk assessment models has been the identification of patients at low risk for serious medical complications. Very little research has been conducted to try and identify intermediate-risk or high-risk patients. This area is open for further study.