Comparison of massive and emergency transfusion prediction scoring systems after trauma with a new Bleeding Risk Index score applied in-flight

PURPOSE: Febrile neutropenia remains a potentially life-threatening complication of anticancer chemotherapy, but some patients are at low risk for serious medical complications. The purpose of this study was to develop an internationally validated scoring system to identify these patients. MATERIALS AND METHODS: Febrile neutropenic cancer patients were observed in a prospective multinational study. Independent factors assessable at fever onset, predicting low risk of complications, on a randomly selected derivation set, were assigned integer weights to develop a risk-index score, which was subsequently tested on a validation set. RESULTS: On the derivation set (756 patients), predictive factors were a burden of illness indicating absence of symptoms or mild symptoms (weight, 5; odds ratio [OR], 8.21; 95% confidence interval [CI], 4.15 to 16.38) or moderate symptoms (weight, 3; OR, 3.70; 95% CI, 2.18 to 6.29); absence of hypotension (weight, 5; OR, 7.62; 95% CI, 2.91 to 19.89); absence of chronic obstructive pulmonary disease (weight, 4; OR, 5.35; 95% CI, 1.86 to 15.46); presence of solid tumor or absence of previous fungal infection in patients with hematologic malignancies (weight, 4; OR, 5.07; 95% CI, 1.97 to 12.95); outpatient status (weight, 3; OR, 3.51; 95% CI, 2.02 to 6.04); absence of dehydration (weight, 3; OR, 3.81; 95% CI, 1.89 to 7.73); and age less than 60 years (weight, 2; OR, 2.45; 95% CI, 1.51 to 4.01). On the validation set, a Multinational Association for Supportive Care in Cancer risk-index score ≥ 21 identified low-risk patients with a positive predictive value of 91%, specificity of 68%, and sensitivity of 71%. CONCLUSION: The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective.

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Prospective Evaluation of Multinational Association of Supportive Care in Cancer Risk Index Score for Gynecologic Oncology Patients With Febrile Neutropenia

American Journal of Clinical Oncology ◽

10.1097/coc.0000000000000498 ◽

2019 ◽

Vol 42 (2) ◽

pp. 138-142 ◽

Cited By ~ 1

Author(s):

Camille C. Gunderson ◽

Britt K. Erickson ◽

Ivy Wilkinson-Ryan ◽

Sara K. Vesely ◽

Charles A. Leath ◽

...

Keyword(s):

Cancer Risk ◽

Febrile Neutropenia ◽

Supportive Care ◽

Risk Index ◽

Gynecologic Oncology ◽

Index Score ◽

Prospective Evaluation ◽

Oncology Patients ◽

Risk Index Score

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Rater

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20678 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20678-e20678

Author(s):

B. Rangarajan ◽

K. Prabhash ◽

R. Nair ◽

H. Menon ◽

P. Jain ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

Predictive Value ◽

Risk Index ◽

Febrile Episode ◽

Index Score ◽

Low Risk ◽

Mascc Score ◽

Sensitivity Specificity ◽

Risk Index Score

e20678 Background: Management of neutropenic fever is based on risk stratification of the episode which helps in optimizing treatment. MASCC is the most commonly used for risk stratification Patients with a score of > 21 were regarded as low risk; patients with a score of <21 were regarded as high risk. We tried to validate the MASCC index for our ethnic population. Methods: Patients were recruited throughout a 12 month period. Inclusion criteria were diagnosis of hematolymphoid malignancy, neutropenic febrile episode secondary to chemotherapy or during induction therapy of acute leukemia and more than 18 years of age All patients were risk stratified, hospitalized and treated with broad-spectrum, empiric, intravenous antibiotic therapy until recovery or outcome of the event. The incidence of medical complications in both groups and death related to the neutropenic infection was recorded. The data was entered on SPSS software and MASCC criteria was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 81 febrile neutropenic episodes were included; 34 classified as low risk and 47 as high risk according to MASCC risk index score. The sensitivity, specificity, PPV, NPV and accuracy of MASCC risk index score were 45.5%, 40%, 11%, 82%, 40.7%. We subsequently analyzed the subset of Acute Myeloid Leukemia (AML) patients as they were the majority comprising of 62/81 episodes. The subset of AML patients risk stratified according to MASCC risk index showed sensitivity, specificity, PPV, NPV and accuracy of 71%, 25.5%, 11%, 87.5%, 31% respectively. Conclusions: In our patient group, the value of MASCC score is limited with poor sensitivity, specificity and PPV. This trend is also seen in the subset analysis of AML patients. The value of the MASCC index with the score of 21 as the cut-off between low risk and high risk seems limited in our patients and requires confirmation with larger set of patients. No significant financial relationships to disclose.

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Scoring Systems for Estimating the Risk of Anticoagulant-Associated Bleeding

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0037-1598061 ◽

2017 ◽

Vol 43 (05) ◽

pp. 514-524 ◽

Cited By ~ 5

Author(s):

Anna Parks ◽

Margaret Fang

Keyword(s):

Clinical Practice ◽

Risk Index ◽

Predictive Ability ◽

Scoring Systems ◽

Bleeding Risk ◽

Assessment Tools ◽

Risk Scores ◽

Bleeding Complications ◽

Individual Risk ◽

Thrombosis Risk

AbstractAnticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS-BLED, ATRIA, and HEMORR2HAGES risk assessment tools, and can be used to help estimate patients' risk for bleeding on anticoagulants. These tools vary by their individual risk components and in how they define and weigh clinical factors. However, it is not yet clear how best to integrate bleeding risk tools into clinical practice. Current bleeding risk scores generally have modest predictive ability and limited ability to predict the most devastating complication of anticoagulation, intracranial hemorrhage. In clinical practice, bleeding risk tools should be paired with a formal determination of thrombosis risk, as their results may be most influential for patients at the lower end of thrombosis risk, as well as for highlighting potentially modifiable risk factors for bleeding. Use of bleeding risk scores may assist clinicians and patients in making informed and individualized anticoagulation decisions.

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The Multinational Association for Supportive Care in Cancer (MASCC) risk index score: 10 years of use for identifying low-risk febrile neutropenic cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-013-1758-y ◽

2013 ◽

Vol 21 (5) ◽

pp. 1487-1495 ◽

Cited By ~ 63

Author(s):

Jean Klastersky ◽

Marianne Paesmans

Keyword(s):

Supportive Care ◽

Cancer Patients ◽

Risk Index ◽

Index Score ◽

Low Risk ◽

Risk Index Score

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Utility of the Multinational Association for Supportive Care in Cancer (MASCC) Risk Index Score as a Criterion for Nonadmission in Febrile Neutropenic Patients with Solid Tumors

The Permanente Journal ◽

10.7812/tpp/14-188 ◽

2015 ◽

Author(s):

Roger Bitar

Keyword(s):

Supportive Care ◽

Solid Tumors ◽

Risk Index ◽

Index Score ◽

Neutropenic Patients ◽

Risk Index Score

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Validation of a scoring system to improve life expectancy prediction in advanced cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20507 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20507-e20507

Author(s):

S. Pourchet ◽

V. Montheil ◽

S. Ropert ◽

J. Alexandre ◽

F. Goldwasser ◽

...

Keyword(s):

Life Expectancy ◽

Cancer Patients ◽

Advanced Cancer ◽

Scoring System ◽

Risk Index ◽

Index Score ◽

Advanced Cancer Patients ◽

Improve Life Expectancy ◽

Validation Set ◽

Risk Index Score

e20507 Background: Oncologists accurately estimates survival in 20% of cases for advanced cancer patients (J Clin Oncol 2005 23:6240–48), leading to prescribe chemotherapy until last weeks of life. This study aimed to develop a validated scoring system to prevent futility. Methods: Between January 2004 and November 2008, 500 evaluable out of 546 consecutive pts with uncurable metastatic solid tumors were entered in a prospective study. On a randomly selected derivation set, independent factors assessable at inclusion predicting 2-weeks survival by a multiple logistic regression, were assigned integer weights to develop a risk-index score, which was subsequently tested on a validation set. Results: On the derivation set (334 pts), predictive factors were: urea > 12 mmol/L (weight = 5; odds ratio (OR) = 3.72; 95% confidence interval (CI) = [1.59; 8.71], p = .002), Karnofsky Performance Status ≤ 30% (weight = 4; OR = 3.28; 95% CI = [1.80; 6.01], p < .001), leucocytes > 15 G/L (weight = 3; OR = 2.49; 95% CI = [1.18; 5.25], p = .017), pre-albumin ≤ 0.05 (weight = 3; OR = 2.42; 95% CI = [1.16; 5.04], p = .019) and male gender (weight = 2; OR = 2.25; 95% CI = [1.28; 3.97], p = .005). On the validation set (166 pts), a risk-index score ≥ 7 identified high risk pts, with a sensitivity of 70 %, specificity of 62 % and a positive predictive value of 78 %. Conclusions: This score could help “go/no go” decisions of chemotherapy in advanced cancer patients and reduces errors of life expectancy prediction from 80% to 22%. No significant financial relationships to disclose.

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