Hyperqbank

_id

683a161cc782e11e38d1b1d8

id

3997

title

Clinical Index of Stable Febrile Neutropenia (CISNE)

full_title

Clinical Index of Stable Febrile Neutropenia (CISNE)

short_title

CISNE

med_description

Identifies febrile neutropenia patients at low risk of serious complications.

short_description

Low-risk febrile neutropenia.

slug

clinical-index-stable-febrile-neutropenia-cisne

description

The Clinical Index of Stable Febrile Neutropenia (CISNE) identifies febrile neutropenia patients at low risk of serious complications.

keywords

Cisne, clinical index, clinical index of stable febrile neutropenia, stable febrile neutropenia, febrile neutropenia

complaint

[ "Fever" ]

formula

Addition of the selected points:

evidence

measurements

[]

information

Interpretation:

CISNE	Risk category	Risk of complications*	Recommendation
0	I (Low)	1.1%	Consider discharge with oral antibiotics after discussion with oncology.
1-2	II (Intermediate)	6.2%	Use clinical judgment regarding admission. Consider oncology consultation.
≥3	III (High)	36%	Admit for further investigation, including blood cultures.

*Any of the following complications within 7 days minumum, from ED arrival until complete resolution of the episode, defined as "disappearance of all signs of infection with recovery from neutropenia (≥1,500 neutrophils/μL) and absence of fever for 48 hours, including home surveillance if patient was discharged early":

Hypotension: persistent systolic blood pressure <90 mmHg requiring inotropes or aggressive fluid resuscitation.
Acute respiratory failure: SaO₂ <90%, PaO₂ <60 mmHg, or PaCO₂ ≥45 mmHg.
Acute renal failure: increase in creatinine >0.3 mg/dL within 48 hours, increase in creatinine to ≥1.5× baseline within prior 7 days, or urine volume <0.5 mL/kg per hour for 6 hours.
Acute heart failure: rapid onset of dyspnea, pulmonary edema, and oxygen desaturation requiring urgent therapy.
Arrhythmia: any that alter cardiovascular stability.
Major bleeding: episodes associated with death, occurring in critical localization (intracranial, intraspinal, intraocular, retroperitoneal, or pericardial), or associated with reduction in hemoglobin values ≥2 g/dL or bleeding requiring transfusion of two units RBCs.
Delirium: acute, fluctuating alteration of mental state with cognitive impairment.
Acute abdomen: requiring urgent medical or surgical management.
Disseminated intravascular coagulation.

refrences

{ "Clinical Practice Guidelines": [ { "href": "https://ascopubs.org/doi/full/10.1200/jco.2012.45.8661", "text": "Flowers CR, Seidenfeld J, Bow EJ, et al. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013;31(6):794-810." } ], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21811253 ", "text": "Carmona-bayonas A, Gómez J, González-billalabeitia E, et al. Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients. Br J Cancer. 2011;105(5):612-7." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891503/", "text": "Fonseca PJ, Carmona-bayonas A, García IM, et al. A nomogram for predicting complications in patients with solid tumours and seemingly stable febrile neutropenia. Br J Cancer. 2016;114(11):1191-8." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25559804 ", "text": "Carmona-bayonas A, Jiménez-fonseca P, Virizuela echaburu J, et al. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol. 2015;33(5):465-71." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/28041827", "text": "Coyne CJ, Le V, Brennan JJ, et al. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department. Ann Emerg Med. 2017;69(6):755-764." } ], "Validations": [] }

pearls

While only solid tumors were included in the original study, an external validation study including both solid and hematologic malignancies showed no significant difference in outcomes for low-risk patients with either type.
Complications included hypotension, acute organ failure, arrhythmia, major bleeding, delirium, acute abdomen, DIC, and “other events considered severe” (see Facts & Figures for full definitions).
Uses mostly objective variables.

usecase

Adult outpatients ≥18 years old with solid tumor, fever ≥38°C (100.4°F) over 1 hour, and neutropenia (500 cells/mm³or fewer, or 1,000 cells/mm³ with expected decrease to 500).
Should not be used in patients who are obviously unwell, defined by the original study authors as any of the following:

Acute organ failure (renal, cardiac, and respiratory).
Decompensation of chronic organ insufficiency.
Septic shock and hypotension (systolic BP <90 mmHg).
Known severe infection.
Other serious complications that would themselves require admission.

reasons

More specific than theMASCC Risk Index.

next_advice

Higher scores indicate higher risk for complications.

next_actions

next_management

As with all prediction tools, use clinical judgment and err on the side of caution when scores are equivocal.

diseases

[ "Cancer", "CML", "HIV/AIDS" ]

input_schema

{ "conditionality": null, "default": 0, "label_en": "<calculator id='3170'>ECOG Performance Status</calculator>", "mdcalc_info_concept": null, "name": "ecog", "option_fhir_rules": null, "optional": false, "options": [ { "label": "<2", "value": 0 }, { "label": "≥2", "value": 2 } ], "show_points": true, "tips_en": "ECOG PS 2 = Capable of all self care, but no work activities, out of bed >50% of day", "type": "radio" }

{ "conditionality": null, "default": 0, "label_en": "Stress-induced hyperglycemia", "mdcalc_info_concept": null, "name": "stress", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "Initial blood glucose ≥121 mg/dL (6.7 mmol/L), or ≥250 mg/dL (13.9 mmol/L) in diabetics or if on steroids", "type": "radio" }

{ "conditionality": null, "default": 0, "label_en": "<abbr title='Chronic obstructive pulmonary disease'>COPD</abbr>", "mdcalc_info_concept": null, "name": "copd", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "COPD diagnosis on therapy with ≥1 of the following: steroids, supplemental O₂, bronchodilators", "type": "radio" }

{ "conditionality": null, "default": 0, "label_en": "Cardiovascular disease history", "mdcalc_info_concept": null, "name": "cvd", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "Chronic heart conditions (e.g., cor pulmonale, heart failure, cardiomyopathy, hypertensive heart disease, arrhythmias, valvular disease, other structural malformations), EXCLUDING history of single uncomplicated episode of AFib", "type": "radio" }

{ "conditionality": null, "default": 0, "label_en": "NCI mucositis grade ≥2", "mdcalc_info_concept": null, "name": "nci", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "Painful erythema, edema, or ulcers, but eating/swallowing possible", "type": "radio" }

{ "conditionality": null, "default": 0, "label_en": "Monocytes", "mdcalc_info_concept": null, "name": "mono", "option_fhir_rules": null, "optional": false, "options": [ { "label": "≥200/µL", "value": 0 }, { "label": "<200/µL", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }

[ { "conditionality": null, "default": 0, "label_en": "<calculator id='3170'>ECOG Performance Status</calculator>", "mdcalc_info_concept": null, "name": "ecog", "option_fhir_rules": null, "optional": false, "options": [ { "label": "<2", "value": 0 }, { "label": "≥2", "value": 2 } ], "show_points": true, "tips_en": "ECOG PS 2 = Capable of all self care, but no work activities, out of bed >50% of day", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "Stress-induced hyperglycemia", "mdcalc_info_concept": null, "name": "stress", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "Initial blood glucose ≥121 mg/dL (6.7 mmol/L), or ≥250 mg/dL (13.9 mmol/L) in diabetics or if on steroids", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "<abbr title='Chronic obstructive pulmonary disease'>COPD</abbr>", "mdcalc_info_concept": null, "name": "copd", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "COPD diagnosis on therapy with ≥1 of the following: steroids, supplemental O₂, bronchodilators", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "Cardiovascular disease history", "mdcalc_info_concept": null, "name": "cvd", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "Chronic heart conditions (e.g., cor pulmonale, heart failure, cardiomyopathy, hypertensive heart disease, arrhythmias, valvular disease, other structural malformations), EXCLUDING history of single uncomplicated episode of AFib", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "NCI mucositis grade ≥2", "mdcalc_info_concept": null, "name": "nci", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "Painful erythema, edema, or ulcers, but eating/swallowing possible", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "Monocytes", "mdcalc_info_concept": null, "name": "mono", "option_fhir_rules": null, "optional": false, "options": [ { "label": "≥200/µL", "value": 0 }, { "label": "<200/µL", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" } ]

instructions

Use in adult outpatients at least 18 years old with solid tumor, fever at least 38°C (100.4°F) over 1 hr, and neutropenia (500 cells/mm³or fewer, or 1,000 cells/mm³ with expected decrease to 500). Do not use in patients with acute organ failure, severe infection, hypotension, or other reason for admission.

published

2022-04-21T20:29:34.356Z

purpose

[ "Diagnosis" ]

search_terms

[ "cisne", "clinical index", "clinical index of stable febrile neutropenia", "stable febrile neutropenia", "febrile neutropenia" ]

seo

{ "keywords_en": "Cisne, clinical index, clinical index of stable febrile neutropenia, stable febrile neutropenia, febrile neutropenia", "meta_description_en": "The Clinical Index of Stable Febrile Neutropenia (CISNE) identifies febrile neutropenia patients at low risk of serious complications." }

specialty

[ "Critical Care", "Family Practice", "Hematology and Oncology", "Infectious Disease", "Internal Medicine" ]

departments

[ "Immunologic", "Infectious", "Oncologic" ]

version_number

versions

[]

[ { "calcId": 3913, "short_title_en": "MASCC Risk Index", "slug": "mascc-risk-index-febrile-neutropenia" }, { "calcId": 10478, "short_title_en": "VURx", "slug": "vesicoureteral-reflux-index-vurx" }, { "calcId": 10547, "short_title_en": "CTCAE", "slug": "common-terminology-criteria-adverse-events-ctcae" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "immunology", "infectious", "oncology" ]

cleaned_use

[ "Adult outpatients ≥18 years old with solid tumor, fever ≥38°C (100.4°F) over 1 hour, and neutropenia (500 cells/mm³or fewer, or 1,000 cells/mm³ with expected decrease to 500).", "Should not be used in patients who are obviously unwell, defined by the original study authors as any of the following:", "Acute organ failure (renal, cardiac, and respiratory).", "Decompensation of chronic organ insufficiency.", "Septic shock and hypotension (systolic BP <90 mmHg).", "Known severe infection.", "Other serious complications that would themselves require admission." ]

pub