[High and low-risk febrile neutropenic patients]

Abstract

IDENTIFICATION OF LOW-RISK PATIENTS: These patients exhibit a low probability of dying (risk equal or lesser than 1%) and of developing major complications (risk to the order of 5%). A clinical model developed by Talcott et al. considers at low risk patients at home when the fever starts, without severe co-morbidity and in whom the neoplasia is under control. A prognostic score was established by the MASCC (Multinational Association for Supportive Care in Cancer); it is based on objectively weighted and selected variables. In comparison, the Talcott's classification appears more restrictive (2.5-fold less patients at low risk) but also that it supplies greater safety. IDENTIFICATION OF HIGH-RISK PATIENTS: All the severity scores used in intensive care have their limits. However, the repeated calculation of severity scores (at 48 and 72 hours) might lead to an improvement in their predictive value. The number of organ dysfunction could also be used because the latter provides supplementary clinical information and hence the development of organ dysfunction scores over the past few Years. For febrile neutropenic patients other than in intensive care, the interest of the severity scores and organ dysfunction scores appears limited.