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MASCC Risk Index for Febrile Neutropenia

Calculators  Multiple body systems
MASCC Risk Index is effecient tool which can predict the risk of poor outcome associated with Febrile neutropenia(FN)
Burden of illness (symptom severity)
As determined by attending physician at presentation
None or mild 5
Moderate 3
Severe 0
sBP (Systolic Blood Pressure) <90 mmHg
No 5
Yes 0
Active COPD
Active chronic bronchitis, emphysema, decreased FEV, or need for oxygen therapy, corticosteroids, and/or bronchodilators
No 4
Yes 0
Cancer type
Solid tumor 4
Hematologic, no prior fungal infection 4
Hematologic, prior fungal infection 0
Dehydration requiring IV fluids
No 3
Yes 0
Status at onset of fever
Outpatient 3
Inpatient 0
Age (years)
<60 2
≥60 0


Measured Factor
MAASC risk score
Measured Factor Disease
  • Febrille neutropeina
Measured Factor Detail
MAASC risk tool helps to analyse the risk for poor outcome in febrile neutropenic patients. MAASC score allows the selection of patients who are at low risk and will get benefit from simplified therapy or need IV medications in high risk patients  It has been used clinically for more than 10 years
Body System
Multiple body systems
Measured Factor Low Impact
  • A score 0 indicates high risk for poor outcome and patient need to be admitted at hospital on IV medication.
Measured Factor High Impact
  • A maximum score of 26 points ensures the low risk for poor outccome and patients can be provided with oral medications.

Result Interpretation

Ranges Ranges
  • Critical Low: <21 points
Result Low Conditions
  • Febrile neutropenia
Test Limitations
MASCC score is costly process and difficult to use | MASCC index can be used in adult patients only
References: 2


Study Validation 1
The aim of this study was to validate the MASCC risk-index score in indentifying those low risk patients of febrile neutropenia (FN) who require less intensive treatment. Out of total 279 population, 105 patients who were at low risk for FN were scrutinized using MASCC risk-index score. This risk-index characterized low-risk patients with a specificity, sensitivity and positive predictive value of 87%, 58%, and 84%, respectively. After final evaluation 64 patients were discharged from the hospital and from them only 3 patients required treatment again.This study finally explained that MASCC risk score can be used as decisive tool in scrutinizing the patients who are at low risk complications and don’t require intensive treatment
References: 3
Study Validation 2
The objective of this study was to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score to identify those patients who are at high or low risk for prognosis of severe medical complications during febrile neutropenia (FN). A total 80 patients with febrile neutropenic episodes were recruited in the study. Out of 80, 58 patients were categorized as low-risk and 22 as high-risk patients by utilizing MASCC risk-index score. 57 of low risk patients were fully recovered while 8 of the high risk patients died. Results showed that this score had predictive value of 98.3% and 86.3% in low and high risk patients respectively. This study concluded that MASCC score accurately identifies low and high risk patients with FN
References: 4
Study Validation 3
This study was conducted in heterogeneous population with aim to validate the utilization of MASCC index score for simplifying treatment in patients who are at low risk for febrile neutropenia (FN). The patients with low risk for complications were scrutinized using MASCC score and were administered with ciprofloxacin and amoxicillin-clavulanate. These patients were then discharged and follow up studies were performed. The primary end point of the study was the rate of resolution of the febrile neutropenic episode without complications, among these early discharged patients. Out of 383 patients 79 patients were discharged and there were no complication among them except three patients who were readmitted. This study concluded that MASCC score was able to identify the patients who were at low risk of developing serious complication after FN episode
References: 5
Study Additional 1
This prospective and observational study was aimed to compare the performance of risk-assessment models in patients with neutropenic fever. A total 53 patients with febrile neutropenic were involved in the study and their MASCC score was calculated. Based on their MASCC score patients were categorized to low risk and high-risk for development of severe complications. 21 of them were marked as low risk with no mortality in any of the patient. The sensitivity and specificity of the MASCC risk-index scores were 87.9 & 85.0 respectively with positive and negative predictive value of 90.6 80.9 respectively. This study concluded that MASCC risk-index score can be used to identify patients who are at low risk of developing serious complications but modified MASCC is much better tool.
References: 6
Study Additional 2
This case control study was conducted with aim to utilize the MASCC model for identifying patients with stable solid tumours with apparent clinical stability.  A total 692 patients with solid tumours and clinical stability were recruited in the study.  MASCC index was evaluated in these patients using prognostic factors (ECOG performance status chronic bronchitis, chronic heart failure, stomatitis, monocytes) and it showed a low sensitivity in detecting complications. This study concluded that MASCC score is not a good index to categorize the patients with stable solid tumor patients.
References: 7


  1. Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000 Aug;18(16):3038-51.
  2. Cosler LE, Sivasubramaniam V, Agboola O, Crawford J, Dale D, Lyman GH. Effect of outpatient treatment of febrile neutropenia on the risk threshold for the use of CSF in patients with cancer treated with chemotherapy. Value Health. 2005;8(1):47-52.
  3. Cherif H, Johansson E, Björkholm M, Kalin M. The feasibility of early hospital discharge with oral antimicrobial therapy in low risk patients with febrile neutropenia following chemotherapy for hematologic malignancies. Haematologica. 2006 Feb;91(2):215-22.
  4. Uys A, Rapoport BL, Anderson R. Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer. 2004 Aug;12(8):555-60.
  5. Klastersky J, Paesmans M, Georgala A, Muanza F, Plehiers B, Dubreucq L, Lalami Y, Aoun M, Barette M. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol. 2006 Sep 1;24(25):4129-34.
  6. de Souza Viana L, Serufo JC, da Costa Rocha MO, Costa RN, Duarte RC. Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer. 2008 Jul;16(7):841-6.
  7. Carmona-Bayonas A, Gómez J, González-Billalabeitia E, Canteras M, Navarrete A, Gonzálvez ML, Vicente V, Ayala de la Peña F. Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients. Br J Cancer. 2011 Aug 23;105(5):612-7. doi: 10.1038/bjc.2011.284

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