MDCalc

Clinical Index of Stable Febrile Neutropenia (CISNE)

Identifies febrile neutropenia patients at low risk of serious complications.

Use in adult outpatients at least 18 years old with solid tumor, fever at least 38°C (100.4°F) over 1 hr, and neutropenia (500 cells/mm³or fewer, or 1,000 cells/mm³ with expected decrease to 500). Do not use in patients with acute organ failure, severe infection, hypotension, or other reason for admission.

ECOG Performance Status
ECOG PS 2 = Capable of all self care, but no work activities, out of bed >50% of day
Stress-induced hyperglycemia
Initial blood glucose ≥121 mg/dL (6.7 mmol/L), or ≥250 mg/dL (13.9 mmol/L) in diabetics or if on steroids
COPD
COPD diagnosis on therapy with ≥1 of the following: steroids, supplemental O₂, bronchodilators
Cardiovascular disease history
Chronic heart conditions (e.g., cor pulmonale, heart failure, cardiomyopathy, hypertensive heart disease, arrhythmias, valvular disease, other structural malformations), EXCLUDING history of single uncomplicated episode of AFib
NCI mucositis grade ≥2
Painful erythema, edema, or ulcers, but eating/swallowing possible
Monocytes

Result:

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Advice

Higher scores indicate higher risk for complications.

Management

As with all prediction tools, use clinical judgment and err on the side of caution when scores are equivocal.

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