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. 2025 Oct 14;25(1):1304.
doi: 10.1186/s12879-025-11713-9.

New scoring system combining WHO ordinal scale and MASCC score in predicting mortality of COVID-19 patients with malignancy and neutropenia: a retrospective cohort study

Pin-Chen Lin  1 , Yan-Bo Huang  2 , Feng-Che Kuan  3 , Chip-Jin Ng  2 , Shou-Yen Chen  4   5
Affiliations

New scoring system combining WHO ordinal scale and MASCC score in predicting mortality of COVID-19 patients with malignancy and neutropenia: a retrospective cohort study

Pin-Chen Lin et al. BMC Infect Dis. .

Abstract

Background: COVID-19 has become a common infectious disease globally and predicting prognosis of hospitalized COVID-19 patients is important, especially for patients with risk factors like febrile neutropenia. Our research aimed to analyze prognostic factors of COVID-19 patients with neutropenia and develop effective scoring system to predict the mortality in these patients.

Methods: Data of COVID-19 patients with neutropenia who presented to the emergency department were extracted from electronic health records across multiple hospitals between April 2021 and September 2022. The primary outcome was in-hospital mortality. Various scoring systems, including the Multinational Association for Supportive Care in Cancer risk index (MASCC) score, World Health Organization (WHO) ordinal scale, and the combination of these two scoring systems, were used and compared for prediction of prognosis.

Results: A total of 304 adult COVID-19 in-hospital patients with neutropenia were included into the study. Higher rates of intubation, oxygen use, and ICU admission were observed in the non-survival group. The MASCC score, the WHO ordinal scale and the combined scoring system showed predictive ability for in-hospital mortality, and the combined scoring system had the best predictive power.

Conclusion: Although MASCC score and WHO ordinal score were useful to predict the prognosis of COVID-19 patients with neutropenia, the new system combining MASCC score and WHO ordinal scale had the best performance in predicting the mortality. Intubation, body temperature, and creatine level were the most significant prognostic factors.

Keywords: COVID-19; MASCC score; Mortality; Prediction; Scoring system; WHO ordinal scale.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the institutional review board of the Chang-Gung Memorial hospital, Taiwan (IRB no. 202401139B0). This is a retrospective study conducted from de-identified database and informed consent of participation is waived by the Institutional Review Board of CGMH, Taiwan. Consent for publication: This is a retrospective study conducted from de-identified database and informed consent of participation and publication is waived by the Institutional Review Board of CGMH, Taiwan (IRB no. 202401139B0). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patient selection
Fig. 2
Fig. 2
The ROC curves and AUC of WHO ordinal scale (2a), MASCC score(2b), and the combined scoring system (2c) for mortality prediction in COVID-19 patients with neutropenia
See this image and copyright information in PMC

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