MASCC Risk Index for Febrile Neutropenia

Higher scores indicate lower risk, with a maximum of 26 points.  Using a cutoff value of >21 points discriminates patients with low risk from those with high risk (<21 points) for serious complications of febrile neutropenia, e.g. death, ICU admission, hypotension (see Formula for complete list).

• The MASCC has been endorsed by the Infectious Disease Society of America (IDSA) since 2002 with Level B (moderate) evidence supporting its use. However, most experts consider high risk patients to be those with anticipated prolonged neutropenia (>7 days), profound neutropenia (ANC <100) and/or co-morbid conditions (in addition to COPD)—Level A evidence—that are not necessarily accounted for in the MASCC. Therefore, clinical judgment by specialists (infectious disease, hematology/oncology or emergency medicine/internal medicine/critical care) with knowledge of predicted disease-specific chemotherapy effects may override the MASCC Score.
• High risk patients require admission for IV antibiotics.
• Carefully-selected low risk patients should receive oral or IV empiric antibiotics in a clinic or hospital setting and may be transitioned to outpatient regimens if they meet certain criteria (see algorithm below).  

*Adapted from the IDSA Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer, 2010.

IDSA recommends admission for empiric antibiotics for high-risk patients not already admitted to the hospital.