MASCC and CISNE Show Similar Mortality Prediction in Stable Febrile Neutropenia

In a prospective emergency department cohort study of clinically stable adults with febrile neutropenia, the Multinational Association for Supportive Care in Cancer (MASCC) risk index and the Clinical Index of Stable Febrile Neutropenia (CISNE) demonstrated statistically indistinguishable discrimination for predicting 30-day and 90-day all-cause mortality among patients with solid tumors.

Febrile neutropenia represents a life-threatening oncologic emergency that requires rapid and accurate clinical risk stratification to guide management decisions in acute healthcare settings. Although both the MASCC risk index and the CISNE score are established clinical tools, comparative evidence regarding their performance for mortality prediction in emergency department populations has remained limited. To evaluate how effectively each risk score identifies clinical deterioration, researchers prospectively evaluated their prognostic performance for both 30-day and 90-day all-cause mortality among patients presenting to an emergency setting.

The investigation, reported by Serhat Bulut, Onatcan Özoğul, Emir Ünal, and Arzu Denizbaşı Altınok in BMC Emergency Medicine, was conducted as a prospective, single-center cohort study at a tertiary emergency department between March 2025 and June 2026. The study enrolled 90 clinically stable adult patients who presented with febrile neutropenia. Among these 90 individuals, 73 patients (81.1 percent) were diagnosed with solid tumors. In the methodological design, MASCC mortality analyses were conducted across the overall cohort, whereas the primary comparative analyses between MASCC and CISNE for mortality prediction were restricted specifically to the subgroup of patients with solid tumors. Performance estimates for CISNE and comparative analyses of major complications across the entire cohort were designated as exploratory. Discrimination was evaluated using receiver operating characteristic curves, and differences in areas under the curve (AUCs) were statistically evaluated using DeLong’s test.

During the follow-up period across the entire 90-patient cohort, all-cause mortality occurred in 14 patients (15.6 percent) at 30 days and in 24 patients (26.7 percent) at 90 days. Within the primary analysis focused on patients with solid tumors, MASCC achieved an AUC of 0.844 (95 percent confidence interval, 0.739 to 0.949) for 30-day all-cause mortality, while CISNE demonstrated an AUC of 0.762 (95 percent confidence interval, 0.651 to 0.874). When evaluating 90-day all-cause mortality in the solid-tumor subgroup, MASCC demonstrated an AUC of 0.739 (95 percent confidence interval, 0.623 to 0.856), whereas CISNE yielded an AUC of 0.770 (95 percent confidence interval, 0.666 to 0.874). According to DeLong’s test, these area-under-the-curve estimates did not differ significantly at 30 days (p = 0.262) or at 90 days (p = 0.635), indicating comparable prognostic discrimination between the two scoring systems.

In addition to mortality outcomes, major complications developed in 32 patients, representing 35.6 percent of the overall study cohort. In an exploratory analysis encompassing all 90 participants, CISNE showed significantly greater discrimination for major complications than MASCC, achieving an AUC of 0.831 compared with 0.681 for MASCC, which corresponded to an absolute difference of 0.150 (95 percent confidence interval, 0.040 to 0.260; DeLong p = 0.008). Risk categorization under CISNE also provided notable risk stratification: among patients classified into either low-risk or intermediate-risk categories by CISNE, zero deaths occurred within 30 days of presentation, reflecting a 30-day mortality rate of 0 out of 39 patients (95 percent confidence interval, 0.0 percent to 9.0 percent).

The researchers concluded that the mortality discrimination of MASCC and CISNE did not differ significantly in the solid-tumor patient subgroup at either 30 or 90 days. While exploratory findings across the full cohort suggested higher discrimination with CISNE for detecting major complications, the study authors emphasized that this result should be interpreted cautiously because the cohort included patients with hematologic malignancies. Because the study was conducted at a single center with a modest sample size of 90 patients, the authors underscored that larger multicenter investigations are necessary to further evaluate and validate these clinical risk stratification tools in emergency department settings.

Subject of Research: Prognostic discrimination of MASCC and CISNE risk scores in emergency department febrile neutropenia

Article Title: MASCC and CISNE for mortality in clinically stable patients with febrile neutropenia: a prospective ED cohort study

Article References: Bulut, S., Özoğul, O., Ünal, E., & Denizbaşı Altınok, A. (2026). MASCC and CISNE for mortality in clinically stable patients with febrile neutropenia: a prospective ED cohort study. BMC Emergency Medicine. https://doi.org/10.1186/s12873-026-01837-9

Image Credits: AI Generated

DOI: 10.1186/s12873-026-01837-9

Keywords: febrile neutropenia, MASCC risk index, CISNE score, emergency department, mortality prediction, risk stratification, oncologic emergencies, solid tumors, MASCC, CISNE, mortality, clinically