MASCC and CISNE for mortality in clinically stable patients with febrile neutropenia: a prospective ED cohort study

Background Febrile neutropenia (FN) is a life-threatening oncologic emergency requiring risk stratification. Evidence comparing the Multinational Association for Supportive Care in Cancer (MASCC) risk index and Clinical Index of Stable Febrile Neutropenia (CISNE) for mortality prediction in emergency department (ED) populations remains limited. We evaluated their prognostic performance for 30- and 90-day all-cause mortality. Methods This prospective, single-center cohort included clinically stable adults with FN presenting to a tertiary ED between March 2025 and June 2026. MASCC mortality analyses included the overall cohort, and primary MASCC–CISNE mortality comparisons were restricted to patients with solid tumors. CISNE estimates and major-complication comparisons in the overall cohort were exploratory. Discrimination was assessed using receiver operating characteristic curves, and areas under the curve (AUCs) were compared using DeLong’s test. Result Among 90 patients, 73 (81.1%) had solid tumors. Thirty- and 90-day mortality occurred in 14 (15.6%) and 24 (26.7%) patients, respectively. Among patients with solid tumors, MASCC and CISNE had the following AUC estimates for 30-day mortality (AUC, 0.844 [95% CI, 0.739–0.949] and 0.762 [0.651–0.874]) and for 90-day mortality (0.739 [0.623–0.856] and 0.770 [0.666–0.874]). Their AUCs did not differ significantly at 30 or 90 days (DeLong p = 0.262 and p = 0.635, respectively). Major complications occurred in 32 patients (35.6%). In an exploratory overall-cohort analysis, CISNE showed greater discrimination than MASCC for major complications (AUC, 0.831 vs. 0.681; difference, 0.150 [95% CI, 0.040–0.260]; DeLong p = 0.008). No 30-day deaths occurred among patients with low- or intermediate-risk CISNE scores (0/39; 95% CI, 0.0%–9.0%). Conclusion The mortality AUCs of MASCC and CISNE did not differ significantly in the solid-tumor subgroup. The exploratory overall-cohort analysis suggested higher discrimination with CISNE for major complications; this finding should be interpreted cautiously because the cohort included hematologic malignancies. Larger multicenter studies are needed. Clinical trial number Not applicable