Mascc Score Calculator

The MASCC risk index is an inverted score: points are awarded for the absence of risk factors, so a high number means a well patient. Burden of illness contributes 5 for mild or 3 for moderate presentation, absence of hypotension with systolic pressure at or above 90 mmHg adds 5, absence of COPD adds 4, a solid tumour or no previous fungal infection adds 4, no dehydration requiring intravenous fluids adds 3, outpatient onset of fever adds 3, and age under 60 adds 2, for a maximum of 26. Low risk is 21 or above. Febrile neutropenia itself means a single oral temperature of 38.3 degrees C or a sustained 38.0 degrees C for one hour, with an absolute neutrophil count below 500 cells per microlitre or expected to fall below it within 48 hours. In the derivation data, patients scoring 21 or more had serious complications in about 6 percent of episodes and mortality under 3 percent, against roughly 39 percent complications and 12 to 36 percent mortality below the threshold, with positive predictive value near 91 percent and specificity near 68 percent. The practical limitation is that a low-risk score is necessary but not sufficient for outpatient oral therapy: guidelines add requirements for oral tolerance, no deep-seated infection, adequate organ function, a reliable caregiver and proximity to a hospital. The burden of illness item is a subjective gestalt that reduces reproducibility between raters, and the index ignores the expected duration of neutropenia, a major driver of infection risk in haematology patients.

Jean Klastersky and colleagues developed the index under the auspices of the Multinational Association for Supportive Care in Cancer, publishing it in the Journal of Clinical Oncology in 2000. The derivation used a prospective multinational study of 1,139 episodes of febrile neutropenia collected across 20 institutions in 15 countries, split into derivation and validation subsets. Logistic regression identified the seven independent predictors of an uncomplicated course, and each was assigned an integer weight proportional to its coefficient. The design goal was explicit: earlier attempts to define low-risk febrile neutropenia, notably the Talcott groups from the late 1980s, were highly specific but identified too few patients to change practice. The clinical context was a shift away from the reflex established in the 1960s and 1970s, when Gerald Bodey and colleagues at the National Cancer Institute demonstrated the relationship between neutrophil depth and infection and empirical intravenous antibiotics for every neutropenic fever became standard. By the 1990s many patients receiving chemotherapy for solid tumours were developing brief, uncomplicated neutropenia, and prolonged admission carried its own costs and nosocomial risks. The MASCC index gave that shift a validated instrument. It was incorporated into the Infectious Diseases Society of America guideline on fever and neutropenia updated by Alison Freifeld and colleagues in 2011, and into NCCN and ASCO guidance. A later alternative, the CISNE score published by Carmona-Bayonas and colleagues in 2015, was developed specifically for clinically stable solid-tumour outpatients where MASCC was judged insufficiently discriminating.