Acil Servise Başvuran Febril Nötropeni Hastalarında MASCC Skorlaması ile Yapılan Hasta Yönetiminin FRAİL Kırılganlık İndeksi Skorları ile Karşılaştırılması ve Değerlendirilmesi: Gözlemsel Çalışma

Abstract

Sarıkaya O. Comparison and Evaluation of Patient Management Based on MASCC Scoring with FRAIL Frailty Index Scores in Febrile Neutropenia Patients Presenting to the Emergency Department: An Observational Study Hacettepe University Faculty of Medicine, Department of Emergency Medicine Thesis of Specialty in Medicine, Ankara, 2026. Febrile neutropenia is a major cause of morbidity and mortality in oncology patients and requires rapid, accurate risk stratification in the emergency department. This study aimed to evaluate the performance of the MASCC score and the FRAIL Frailty Index—individually and in combination—in predicting mortality and safe discharge among oncology patients presenting to the emergency department with febrile neutropenia, and to determine whether a combined model derived from the two instruments provides incremental predictive value. In this prospective observational study, 276 oncology patients presenting with febrile neutropenia were enrolled. MASCC and FRAIL scores were calculated at admission, and clinical course, hospitalization, safe discharge, and mortality outcomes were recorded. Because the two instruments are scored in opposite directions, the MASCC score was inverted relative to its maximum value and combined using the formula Combined Score = FRAIL + (26 − MASCC). Diagnostic performance was assessed by ROC curve analysis. The median age was 64.0 years, 51.8% were female, and the overall mortality rate was 15.6%. Both the MASCC and FRAIL scores were independently and significantly associated with mortality and clinical outcome. The combined model achieved an AUC of 0.757 for mortality prediction (negative predictive value 0.913; specificity 0.807) and 0.717 for safe discharge prediction (specificity 0.730), outperforming either score alone. Neither score significantly predicted length of hospital stay (MASCC p = 0.099; FRAIL p = 0.144). In conclusion, adding the FRAIL Frailty Index to the MASCC score provides incremental value in predicting mortality and safe discharge in patients with febrile neutropenia; integrating frailty assessment into risk stratification yields discriminative ability that cannot be obtained with MASCC alone.

Keywords: MASCC, FRAIL, febrile neutropenia, frailty, risk stratification