CISNE score (Clinical Index of Stable Febrile Neutropenia)
Risk of serious complications in apparently stable febrile neutropenia (solid tumours)
- FINITE study (Spain)
Sources last checked: 2026-10-13
CISNE score (Clinical Index of Stable Febrile Neutropenia)
Risk of serious complications in apparently stable febrile neutropenia (solid tumours)
Serious complications 1.1 %, mortality 0 % in derivation and validation.
Only for outpatients with solid tumours on standard-dose chemotherapy who look clinically stable (no organ dysfunction, abnormal vital signs or major infection). Not for haematological malignancies or unstable patients — they are already high risk.
Interpretation
| 0 — low risk | Serious complications 1.1 %, mortality 0 % in derivation and validation. |
|---|---|
| 1–2 — intermediate risk | Serious complications ≈ 6 %, mortality 0–1.6 %. |
| ≥ 3 — high risk | Serious complications 32.5–36 %, mortality 3.1–4.3 %. |
What is the CISNE score (Clinical Index of Stable Febrile Neutropenia)?
The Clinical Index of Stable Febrile Neutropenia (CISNE) predicts serious complications in patients with solid tumours whose febrile neutropenia appears clinically stable. Six factors — ECOG ≥ 2, stress-induced hyperglycaemia, COPD, chronic cardiovascular disease, mucositis grade ≥ 2 and monocytes < 200/µL — give 0–8 points. It was developed in Spain and validated prospectively in 1,133 patients from 25 hospitals (FINITE study, 2015).
When to use it
- In outpatients with solid tumours on standard-dose chemotherapy who present with febrile neutropenia and look stable
- To detect hidden high risk in patients who would otherwise be considered for outpatient care
- Alongside the MASCC index
When not to use it
- In haematological malignancies or after stem-cell transplantation
- In patients with organ dysfunction, abnormal vital signs or major infection — they are not 'stable' and are already high risk
How it is calculated
| Criterion | Points |
|---|---|
| ECOG performance status ≥ 2 | +2 |
| Stress-induced hyperglycaemia | +2 |
| Chronic obstructive pulmonary disease | +1 |
| Chronic cardiovascular disease | +1 |
| Mucositis NCI grade ≥ 2 | +1 |
| Monocytes < 200/µL | +1 |
Clinical pearls and limitations
- Only for outpatients with solid tumours on standard-dose chemotherapy who look clinically stable (no organ dysfunction, abnormal vital signs or major infection). Not for haematological malignancies or unstable patients — they are already high risk.
- In validation CISNE discriminated better than MASCC (AUC 0.868 vs 0.721) in this stable population.
- Even an intermediate score (1–2) carries about 6 % risk of serious complications.
- Monocytes come from the differential count and are often overlooked.
Frequently asked questions
What CISNE score is high risk?
3 or more points. Serious complications occurred in 32.5–36 % of these patients.
Who is CISNE for?
Adults with solid tumours on standard chemotherapy whose febrile neutropenia looks clinically stable.
Is CISNE better than MASCC?
In the stable solid-tumour population it was designed for, it discriminated better. It does not apply to haematological patients.
Evidence and guidelines
- Primary source: Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, et al. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol 2015;33(5):465-471.
- Klastersky J et al. The MASCC risk index. J Clin Oncol 2000;18(16):3038-3051 (comparator; CISNE AUC 0.868 vs MASCC 0.721 in the validation subset).
Have a follow-up question?
Medelix answers clinical questions from current guidelines and studies — every statement with its source.
Ask Medelix about the CISNE score (Clinical Index of Stable Febrile Neutropenia)Related calculators
Embed this calculatorFree to use on your website, intranet or teaching page. Copy the code below.
<iframe src="https://medelix.ai/en/embed/cisne" title="CISNE score (Clinical Index of Stable Febrile Neutropenia) – Medelix" width="100%" height="620" style="border:0;max-width:720px" loading="lazy"></iframe>
<p><a href="https://medelix.ai/en/calculators/cisne-score">CISNE score (Clinical Index of Stable Febrile Neutropenia) calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.