{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:37:14Z","timestamp":1788280634458,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: Febrile neutropenia is a common oncologic emergency with significant morbidity and mortality. Although the MASCC (Multinational Association for Supportive Care in Cancer) score is widely used for risk stratification, its limited sensitivity and lack of laboratory parameters reduce its prognostic utility. This study aimed to evaluate whether incorporating serum lactate and CRP measurements into the MASCC score enhances its predictive performance for hospital admission and the 30-day mortality. Methods: This retrospective diagnostic accuracy study included adult patients diagnosed with febrile neutropenia in the emergency department of a tertiary care hospital between January 2021 and December 2024. The original MASCC score was calculated, and three modified models were derived: the MASCC-L (lactate\/MASCC), MASCC-C (CRP\/MASCC) and MASCC-LC models (CRP \u00d7 lactate\/MASCC). The predictive accuracy for hospital admission and the 30-day all-cause mortality was assessed using ROC analysis. Results: A total of 269 patients (mean age: 67.6 \u00b1 12.4 years) were included; the 30-day mortality was 3.0%. The MASCC-LC model demonstrated the highest discriminative ability for mortality prediction (area under the curve (AUC): 0.995; sensitivity: 100%; specificity: 98%). For hospital admission prediction, the MASCC-C model had the highest specificity (81%), while the MASCC-LC model showed the best balance of sensitivity and specificity (both 73%). All the modified models outperformed the original MASCC score regarding both endpoints. Conclusions: Integrating lactate and CRP measurements into the MASCC score significantly improves its prognostic accuracy for both mortality and hospital admission in febrile neutropenic patients. The MASCC-LC model, relying on only three objective parameters, may serve as a practical and efficient tool for early risk stratification in emergency settings.<\/jats:p>","DOI":"10.3390\/diagnostics15151922","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T08:51:41Z","timestamp":1754038301000},"page":"1922","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Improving Prognostic Accuracy of MASCC Score with Lactate and CRP Measurements in Febrile Neutropenic Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0208-950X","authenticated-orcid":false,"given":"Efe","family":"Kanter","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35620 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ecem Ermete","family":"G\u00fcler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35620 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00fcleyman","family":"K\u0131r\u0131k","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35620 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9641-4176","authenticated-orcid":false,"given":"Tutku Duman","family":"\u015eahan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Cesme Alper Cizgenakat State Hospital, 35930 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melisa Buse","family":"Bayg\u0131n","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35620 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emine","family":"Alt\u0131n\u00f6z","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35620 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2448-2337","authenticated-orcid":false,"given":"Ejder Saylav","family":"Bora","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35620 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Karakaya","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35620 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Shmuely, H., Monely, L., and Shvidel, L. (2023). All-Cause Mortality and Its Predictors in Haemato-Oncology Patients with Febrile Neutropenia. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175635"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/oncolo\/oyac074","article-title":"Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?","volume":"27","author":"Boccia","year":"2022","journal-title":"Oncologist"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Casanovas-Blanco, M., and Serrahima-Mackay, A. (2020). Febrile neutropenia management in cancer patients receiving anti-cancer agents\u2019 treatment: Deepening the search to offer the best care. A critical review follow-up. Crit. Rev. Oncol. Hematol., 153.","DOI":"10.1016\/j.critrevonc.2020.103042"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ajem.2021.07.008","article-title":"Emergency department management of chemotherapy related febrile neutropenia: An opportunity to improve care","volume":"50","author":"Pettit","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1097\/CCM.0000000000003803","article-title":"Clinician Perception of a Machine Learning-Based Early Warning System Designed to Predict Severe Sepsis and Septic Shock","volume":"47","author":"Ginestra","year":"2019","journal-title":"Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4103\/cmi.cmi_37_20","article-title":"Febrile neutropenia in the emergency department","volume":"19","author":"Paul","year":"2021","journal-title":"Curr. Med. Issues"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Zheng, B., Toarta, C., Cheng, W., Taljaard, M., Reaume, N., and Perry, J.J. (2020). Accuracy of the MASCC and CISNE scores for predicting serious complications in adult patients with febrile neutropenia: A systematic review and meta-analysis. Crit. Rev. Oncol. Hematol., 149.","DOI":"10.1016\/j.critrevonc.2020.102922"},{"key":"ref_8","first-page":"1047","article-title":"Effect of serum uric acid level and MASCC risk score on febrile neutropenia mortality","volume":"29","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s12288-016-0730-7","article-title":"Validation of MASCC score for risk stratification in patients of hematological disorders with febrile neutropenia","volume":"33","author":"Taj","year":"2017","journal-title":"Indian J. Hematol. Blood Transfus."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"8475","DOI":"10.1002\/cam4.4355","article-title":"The role of procalcitonin in identifying high-risk cancer patients with febrile neutropenia: A useful alternative to the MASCC score","volume":"10","author":"Chaftari","year":"2021","journal-title":"Cancer Med."},{"key":"ref_11","first-page":"1009","article-title":"C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms","volume":"23","author":"Combariza","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_12","first-page":"5905","article-title":"Use of MASCC score in the inpatient management of febrile neutropenia: A single-center retrospective study","volume":"29","author":"Bhardwaj","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.jemermed.2020.12.010","article-title":"Prognostic Value of Serum Procalcitonin Levels in Patients with Febrile Neutropenia Presenting to the Emergency Department","volume":"60","author":"Yadav","year":"2021","journal-title":"J. Emerg. Med."},{"key":"ref_14","first-page":"2815","article-title":"The prognostic performance of adding patient-reported outcomes to the MASCC risk index to identify low-risk febrile neutropenia patients with solid tumors and lymphomas","volume":"25","author":"Wang","year":"2017","journal-title":"Support. Care Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1515\/cclm-2023-0086","article-title":"Why C-reactive protein is one of the most requested tests in clinical laboratories?","volume":"61","author":"Plebani","year":"2023","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Paranga, T.G., Pavel-Tanasa, M., Constantinescu, D., Plesca, C.E., Petrovici, C., Miftode, I.L., Moscalu, M., Cianga, P., and Miftode, E.G. (2023). Comparison of C-reactive protein with distinct hyperinflammatory biomarkers in association with COVID-19 severity, mortality and SARS-CoV-2 variants. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1213246"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rivest, C.\u00c9., Ben Abderrazik, F.E., C\u00f4t\u00e9-Marcoux, M.A., Malick, M., Hanel, R., and Pavic, M. (2024). Retrospective study on the correlation between MASCC score and the evolution of febrile neutropenia for patients with solid cancer. J. Clin. Oncol., 42.","DOI":"10.21203\/rs.3.rs-6606114\/v1"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jped.2020.05.002","article-title":"Evaluation of risk stratification strategies in pediatric patients with febrile neutropenia","volume":"97","author":"Janssens","year":"2021","journal-title":"J. Pediatr. (Rio J.)"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Phillips, B., and Morgan, J.E. (2021). Meta-analytic validation of new \u2018AUS\u2019 febrile neutropenia risk score. Pediatr. Blood Cancer, 68.","DOI":"10.1002\/pbc.28580"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Klastersky, J.A. (2014). Management of the non-low-risk patients with febrile neutropenia. Febrile Neutropenia, Springer Healthcare.","DOI":"10.1007\/978-1-907673-70-2"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Luz Fiusa, M.M., Costa-Lima, C., de Souza, G.R., Vigorito, A.C., Penteado Aranha, F.J., Lorand-Metze, I., Annichino-Bizzacchi, J.M., de Souza, C.A., and De Paula, E.V. (2013). A high angiopoietin-2\/angiopoietin-1 ratio is associated with a high risk of septic shock in patients with febrile neutropenia. Crit. Care, 17.","DOI":"10.1186\/cc12848"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1093\/labmed\/lmab002","article-title":"Usage of Plasma Presepsin, C-Reactive Protein, Procalcitonin and Proadrenomedullin to Predict Bacteremia in Febrile Neutropenia of Pediatric Hematological Malignancy Patients","volume":"52","author":"Aytac","year":"2021","journal-title":"Lab. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.62347\/JRMG1142","article-title":"Predictors of febrile neutropenia in small cell lung cancer patients receiving concurrent chemoradiotherapy with etoposide and cisplatin: A focus on nutritional status, inflammation and performance status","volume":"15","author":"Zhang","year":"2025","journal-title":"Am. J. Cancer Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Dimitrijevi\u0107, J., \u010calama\u0107, M., \u0110urmez, O., and Stojanovi\u0107, M. (2025). PCT-to-albumin ratio and CRP-to-albumin ratio as predictors of febrile neutropenia complications: A prospective observational trial. Support. Care Cancer, 33.","DOI":"10.1007\/s00520-025-09329-5"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Mi\u0161ura Jakobac, K., Milunovi\u0107, V., Ku\u0161ec, V., Hraba\u010d, P., Martinovi\u0107, M., Radi\u0107-Kri\u0161to, D., Ostoji\u0107 Koloni\u0107, S., and Pavli\u0161a, G. (2025). Biomarkers affecting treatment outcomes of febrile neutropenia in hematological patients with lymphomas: Is presepsin the new promising diagnostic and prognostic biomarker?. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072238"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1080\/07853890.2022.2031271","article-title":"Usefulness of complete blood count parameters to predict poor outcomes in cancer patients with febrile neutropenia presenting to the emergency department","volume":"54","author":"Choi","year":"2022","journal-title":"Ann. Med."},{"key":"ref_27","first-page":"841","article-title":"Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients","volume":"16","author":"Serufo","year":"2008","journal-title":"Support. Care Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lee, S., Song, J., Lee, S., Kim, S.J., Han, K.S., and Lee, S. (2024). Impact of Point-of-Care Lactate Testing for Sepsis on Bundle Adherence and Clinical Outcomes in the Emergency Department: A Pre\u2013Post Observational Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185389"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ackermann, K., Baker, J., Green, M., Fullick, M., Varinli, H., Westbrook, J., and Li, L. (2022). Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Adult Inpatients: Scoping Review. J. Med. Internet Res., 24.","DOI":"10.2196\/31083"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Alsharawneh, A. (2025). The Multinational Association for Supportive Care in cancer criteria. An Evaluation and recommendations for the management of neutropenia in the emergency department. Int. Emerg. Nurs., 78.","DOI":"10.1016\/j.ienj.2024.101542"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/15\/1922\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:19:32Z","timestamp":1760033972000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/15\/1922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":30,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15151922"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15151922","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]}}}