Cisne score : validación de una escala clínica pronóstica en pacientes oncológicos con neutropenia febril
Fecha
2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
La neutropenia febril e suna complicación frecuente en la población oncológica sometida a quimioterapia predisponiendo al paciente a infecciones graves que pueden comprometer su vida. El objetivo de esta investigación fue determinar la validez de la escala CISNE en pacientes oncológicos con neutropenia febril en el Instituto Oncológico Nacional "Hospital Juan Tanca Marengo" en el período de Enero-2015 a Junio-2016. Se realizó un estudio transversal , analítico no experimental, con un cohorte de 163 casos, se evaluó las escalas pronósticas CISNE y MASCC mediante test de pruebas diagnósticas frente a complicaciones y mortalidad. Además se comparó ambas escalas mediante la utilización de curvas ROC. La tabulación se realizó mediante Microsoft Excel 2010 y el análisis estadístico mediante SPSS v22 de IBM. De lso 163 pacientes , 27.6% presentaron complicaciones y 15.3% fallecieron. La escala MASCC para complicaciones, reporto una sensibilidad de 80%, especificidad de 73.7% , VPP de 53.7% y VPN de 90.6% y vs. mortalidad reporto una sensibilidad 88% , especificidad 67%, VPP 33% y VPN 97%. La escala CISNE para complicaciones reporto una sensibilidad de 91.11%, especificidad de 24.57%, VPP de 31.53% y VPN de 87.87% vs. mortalidad reporto una sensibilidad 96%, especificidad 23.18%, VPP 18.46% y VPN 96.96%. Las áreas bajo la curva para complicaciones fueron de 0.159 (95% CI, 0.085 - 0.233) para la escala MASCC y 0.645 (95%CI, 0.547 - 0.742) para la CISNE. Frente a mortalidad 0.154 (95%CI, 0.083 - 0.225) para MASCC y 0.794 (95%CI, 0.689 - 0.900). Se concluyó que la escala CISNE puede estratificar según riesgo a los pacientes con neutropenia febril pero no muestra ventajas significativas a la escala MASCC.
Febrile neutropenia is a frequent complication in the cancer population undergoing chemotherapy, predisposing the patient to serious infections that can compromise their lives. The objective of this investigation was to determine the validity of the CISNE scale in cancer patients with febrile neutropenia in the National Oncological Institute "Hospital Juan Tanca Marengo" in the period from January-2015 to June-2016. A cross-sectional, non-experimental analytical study was carried out, with a cohort of 163 cases, the prognostic scales CISNE and MASCC were evaluated by means of a test of diagnostic tests against complications and mortality. In addition, both scales were compared using ROC curves. The tabulation was performed using Microsoft Excel 2010 and the statistical analysis using IBM SPSS v22. Of the 163 patients, 27.6% had complications and 15.3% died. The MASCC scale for complications, reported a sensitivity of 80%, specificity of 73.7%, PPV of 53.7% and NPV of 90.6% and vs. Mortality reported a sensitivity of 88%, specificity 67%, PPV 33% and NPV 97%. The scale CISNE for complications reported a sensitivity of 91.11%, specificity of 24.57%, PPV of 31.53% and NPV of 87.87% vs. Mortality reported a sensitivity of 96%, specificity 23.18%, PPV 18.46% and NPV 96.96%. The areas under the curve for complications were 0.159 (95% CI, 0.085 - 0.233) for the MASCC scale and 0.645 (95% CI, 0.547 - 0.742) for the CISNE. Against mortality 0.154 (95% CI, 0.083 - 0.225) for MASCC and 0.794 (95% CI, 0.689 - 0.900). It was concluded that the CISNE scale can stratify according to risk to patients with febrile neutropenia but does not show significant advantages at the MASCC scale.
Febrile neutropenia is a frequent complication in the cancer population undergoing chemotherapy, predisposing the patient to serious infections that can compromise their lives. The objective of this investigation was to determine the validity of the CISNE scale in cancer patients with febrile neutropenia in the National Oncological Institute "Hospital Juan Tanca Marengo" in the period from January-2015 to June-2016. A cross-sectional, non-experimental analytical study was carried out, with a cohort of 163 cases, the prognostic scales CISNE and MASCC were evaluated by means of a test of diagnostic tests against complications and mortality. In addition, both scales were compared using ROC curves. The tabulation was performed using Microsoft Excel 2010 and the statistical analysis using IBM SPSS v22. Of the 163 patients, 27.6% had complications and 15.3% died. The MASCC scale for complications, reported a sensitivity of 80%, specificity of 73.7%, PPV of 53.7% and NPV of 90.6% and vs. Mortality reported a sensitivity of 88%, specificity 67%, PPV 33% and NPV 97%. The scale CISNE for complications reported a sensitivity of 91.11%, specificity of 24.57%, PPV of 31.53% and NPV of 87.87% vs. Mortality reported a sensitivity of 96%, specificity 23.18%, PPV 18.46% and NPV 96.96%. The areas under the curve for complications were 0.159 (95% CI, 0.085 - 0.233) for the MASCC scale and 0.645 (95% CI, 0.547 - 0.742) for the CISNE. Against mortality 0.154 (95% CI, 0.083 - 0.225) for MASCC and 0.794 (95% CI, 0.689 - 0.900). It was concluded that the CISNE scale can stratify according to risk to patients with febrile neutropenia but does not show significant advantages at the MASCC scale.
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Neutropenia febril, Score Cisne, Score Mascc, Epidemiología analítica, Oncología médica, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador