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CISNE or MASCC, which predictor is really the weakest in febrile neutropenia?

Published:November 20, 2017DOI:https://doi.org/10.1016/j.ejim.2017.11.009
      Daniel Kahneman convincingly disputes that heuristic shortcuts produce cognitive biases; large doses of patience and reflection are needed to counteract them [
      • Tversky A.
      • Kahneman D.
      Availability: a heuristic for judging frequency and probability.
      ], although sometimes this is impossible to achieve. Cooksley et al. have recently published a brief review of the literature on Febrile Neutropenia (FN), using potentially inconsistent arguments [
      • Knight T.
      • Ahn S.
      • Rice T.W.
      • Cooksley T.
      Acute oncology care: a narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors.
      ]. The authors cite the result of an independent series that proves the Clinical Index of Stable Febrile Neutropenia (CISNE) to be superior to the Multinational Association of Supportive Care in Cancer (MASCC) score in predicting neutropenic complications [
      • Coyne C.J.
      • Le V.
      • Brennan J.J.
      • Castillo E.M.
      • Shatsky R.A.
      • Ferran K.
      • et al.
      Application of the MASCC and CISNE risk-stratification scores to identify low-risk febrile neutropenic patients in the emergency department.
      ]. Conversely, Cooksley et al. conclude in the same paragraph that CISNE is a weaker predictor of complications, thus contradicting the initial statement. The FINITE study, a prospective and multicenter series, demonstrated greater accuracy for the CISNE score, with an area under the Receiver Operating Characteristic (ROC) curve of 0.868 vs. 0.721 for the MASCC score (P = 0.002) for predicting complications [
      • Carmona-Bayonas A.
      • Jiménez-Fonseca P.
      • Echaburu J.V.
      • Antonio M.
      • Font C.
      • Biosca M.
      • 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.
      ,
      • Fonseca P.J.
      • Carmona-Bayonas A.
      • García I.M.
      • Marcos R.
      • Castañón E.
      • Antonio M.
      • et al.
      A nomogram for predicting complications in patients with solid tumours and seemingly stable febrile neutropenia.
      ,
      • Carmona-Bayonas A.
      • Gómez J.
      • González-Billalabeitia E.
      • Canteras M.
      • Navarrete A.
      • Gonzálvez M.L.
      • et al.
      Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients.
      ]. Moreover, the analysis of heterogeneity by centres reproduced exactly the same trends in each of the 23 hospitals in this registry. The following year, researchers from the University of Salamanca confirmed for the third time the highest accuracy of the CISNE score [
      • Fonseca P.J.
      • Carmona-Bayonas A.
      • García I.M.
      • Marcos R.
      • Castañón E.
      • Antonio M.
      • et al.
      A nomogram for predicting complications in patients with solid tumours and seemingly stable febrile neutropenia.
      ].

      Keywords

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