1863P - Circulating biomarkers for risk stratification of cancer patients with chemotherapy associated febrile neutropenia

Background

Febrile neutropenia (FN) is one of the most common and severe complications in cancer patients. Although the Multinational Association for Supportive Care in Cancer (MASCC) score is the predominant approach for distinguishing low and high-risk episodes of FN, it relies on clinical indicators. Biomarkers of inflammation could provide additional information in the emergency department (ED). Hence, mid-regional proadrenomedullin (MR-proADM) has emerged as a useful tool. We aimed to evaluate the role of MR-proADM for risk stratification of FN episodes, compared to MASCC score, C-reactive protein (CRP) and procalcitonin (PCT), in predicting serious complications.

Methods

Prospective study including chemotherapy-related FN episodes in patients with solid tumors presenting to the ED. A blood sample was collected to determine CRP, PCT and MR-proADM levels. The main outcome was ICU admission and/or death. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of biomarkers and MASCC score for outcome. Optimal cutoffs were calculated through Youden index.

Results

Population study included 173 episodes (median age 61; interquartile range (IQR) 52-59; 105 (60.7%) female). ICU admission and/or death occurred in 17 (9.8%) episodes. Median CRP, PCT and MR-proADM levels were significantly higher in patients requiring ICU management and/or deceased (p < 0.001): 303 vs 82.5 mg/dL, 7.45 vs 0.17 ng/mL, 3.14 vs 1.02 nmol/L, respectively. MASCC score was significantly lower: 18 vs 24, p < 0.001. In ROC curve analyses, MR-proADM had the highest discriminatory ability (AUC 0.94), without a significant difference with PCT (p 0.47). This difference was significant in comparison with CPR (p 0.03) and MASCC score (p 0.01). Optimal cutoffs are described in the table. Table: 1863P

Conclusions

In chemotherapy-associated FN patients, PCT and MR-proADM achieved a high performance for risk stratification and could assist us in the management in the ED.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.