Table 4 Main features of the patients and the febrile episodes Characteristic ECOG performance status 0 – 1 Tumours Breast Lung Lymphoma Sarcoma Colorectal Other solid tumours Treatment setting Adjuvant Neoadjuvant Advanced disease/palliative Other TNM stage IV MASCCX21 Cause of the fever Fever of unknown origin Clinically confirmed infection Microbiologically confirmed infection Days with neutropaenia p500 mm 3 Length of admission Rate of unexpected complications Rate of bacteraemia Percentage of Gram negative in blood cultures Median age, years Abbreviation: ECOG ¼ Eastern Cooperative Oncology Group. N (%) 138 (78) 53 (30) 41 (23.4) 31 (18) 13 (7.5) 7 (4) 30 (17) 33 (19) 15 (8) 96 (55) 31 (18) 96 (55) 144 (85) 80 (37) 84 (39) 51 (24) 3 (range 1 – 8) 7.4 days 7.3 6.2 65 55 (range 13 – 85) negative likelihood ratio 0.6 and correct classification 89%. The application of MASCC reduced the unexpected complications from 7.3 to 5.1%. These calculations suggest a poor performance of the model in stable patients, as 64% of the cases with complications have a MASCC score X21. When the variables included in the MASCC score were analysed, we found that no patient had hypotension or previous invasive fungal infection, the in-patient status was 0% and the rate of dehydration was 7% (n ¼ 13), as expected. The remaining three variables occurred relatively more often: COPD was present in 20% (n ¼ 35), moderate burden of disease in 39% and age 460 yeas in 42% (n ¼ 71). DISCUSSION Febrile neutropaenia is associated with significant morbidity and mortality in cancer patients. The MASCC index has been validated in the whole spectrum of FN and it is a precise tool for risk stratification (Klastersky et al, 2000). However, even in the low- risk group, around 10% of patients develop serious complications (Klastersky et al, 2006). Our study was designed from a pragmatic point of view. We hypothesised that our target population was considerably homo- geneous and differed from the samples in which Talcott and MASCC models were developed. We excluded the cases with acute leukaemia, HDC and BMT, which selected for patients with an anticipated short duration of neutropaenia and a lower risk of complications. We also excluded in-patients because this prior status is considered a risk factor for complications according to MASCC and Talcott’s models (Talcott et al, 1992). Moreover, an ultimate goal of prognostic models of low-risk FN is to identify a & 2011 Cancer Research UK Febrile neutropaenia in apparently stable outpatients A Carmona-Bayonas et al Table 5 Predictive factors for serious complications in the univariate analysis 615 Variables Baseline characteristics and medical history Age, years o65 30 (58.8) 93 (78.2) X65 21 (41.2) 26 (21.8) Cases, n (%) Controls, n (%) Sex Female Male 17 (33.3) 34 (66.7) 74 (62.2) 45 (37.8) Surgery in the previous month No 47 (92) 108 (88.5) Yes 4 (8) 14 (11.5) ECOG performance status o2 32 (62.7) X2 19 (37.3) 106 (89.1) 13 (10.9) Antibiotics in the previous month No 32 (62.7) 90 (73.7) Yes 19 (37.3) 32 (26.3) OR 95% CI P-value 2.5 1.23 – 5.07 3.28 1.65 – 6.55 0.2 – 2.1 2.1 – 10.86 o0.0001 0.83 – 3.35 0.14 1.7 – 6.92 o0.0001 7.32 3.25 – 16.5 o0.0001 8.21 2.12 – 31.8 o0.0001 0.6 4.84 1.6 4.43 0.9 1.45 0.84 0.65 1.46 0.3 – 6.3 3.43 1.66 – 7.23 0.34 0.13 – 0.7 0.41 – 2.29 0.7 – 2.8 0.3 – 2.15 0.2 – 1.55 0.010 0.001 0.6 0.69 0.01 0.04 0.57 0.31 0.72 0.4 s e i d u t S l a c i n i l C Constitutional syndrome No 26 (51) Yes 25 (49) Chronic bronchitis No 28 (54.9) Yes 23 (45.1) Chronic heart failure No 42 (82.4) Yes 9 (17.6) Diabetes mellitus No Yes Lung cancer No Yes Breast cancer No Yes Lymphoma No Yes TNM stage I – III IV 48 (94.1) 3 (5.9) 30 (58.8) 21 (41.1) 43 (84.3) 8 (15.7) 42 (82.3) 9 (17.7) 20 (39.2) 31 (60.8) Prophylactic GCSF No 44 (86.2) Yes 7 (13.8) Adjuvant chemotherapy No 43 (84.3) Yes 8 (15.7) Laboratory results Albumin, mg dl 1 X3 29 (59.2) o3 20 (40.8) Total proteins, mg dl 1 X6.4 7 (14.6) o6.4 41 (85.4) 93 (78.2) 26 (21.8) 107 (89.9) 12 (10.1) 115 (97.5) 3 (2.5) 117 (95) 5 (5) 99 (83.2) 20 (16.8) 74 (62.2) 45 (37.8) 100 (81.9) 22 (18.1) 59 (48.3) 63 (51.7) 101 (82.7) 19 (17.3) 95 (77.8) 27 (22.2) 91 (78.4) 25 (21.6) 59 (51.3) 56 (58.7) 2. 51 1.22 – 5.16 0.011 6.17 2.55 – 14.8 o0.0001 British Journal of Cancer (2011) 105(5), 612 – 617