Calc Function

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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
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    Patent Pending

    Clinical Index of Stable Febrile Neutropenia (CISNE)

    Identifies febrile neutropenia patients at low risk of serious complications.
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    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.

    When to Use
    Pearls/Pitfalls
    Why 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.
    • 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.

    More specific than the MASCC Risk Index.

    <2
    0
    ≥2
    +2
    No
    0
    Yes
    +2
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    ≥200/µL
    0
    <200/µL
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Higher scores indicate higher risk for complications.

    Management

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

    About the Creator
    Dr. Alberto Carmona-Bayonas
    Are you Dr. Alberto Carmona-Bayonas?
    Dr. Paula Jiménez Fonseca
    Are you Dr. Paula Jiménez Fonseca?