About this app

Welcome to the Clinical Index of Febrile Neutropenia (CISNE) calculator. This tool was developed by the Supportive Care Working Group of the Spanish Society of Medical Oncology (SEOM) between 2012 and 2014 in 1133 adult patients with seemingly stable febrile neutropenia from 25 hospitals.

Its objective is to identify those patients with chemotherapy-related febrile neutropenia who are seemingly stable in the first hours and who throughout the evolution of their febrile process develop serious, unexpected complications and who, therefore, despite the initial lack of evident criteria of severity, are not truly stable. Some will have acute respiratory insufficiency, others will have shock, etc., and the first signs of alarm will not always be detectable at the first evaluation or triage in the Emergency Department.

The scope of the model’s applicability must always be confirmed and attention must be paid to unusual risk factors that may be important in a minority of patients. The CISNE score should not be used to select low risk patients who are eligible for outpatient care with oral antibiotics, until a clinical trial can be carried out to confirm the safety of this approach.

Patients should be clinically stable within the first 3 hours after diagnosis of FN. Clinical stability included all of the following: absence of acute organ failure (renal, cardiac, and respiratory) and decompensation of chronic organ insufficiency, absence of septic shock and hypotension (systolic pressure < 90 mm/Hg), no known severe infections, and absence of other serious complications, constituting admission criteria in and of themselves. Patients with acute leukemia, bone marrow transplantation or high-dose chemotherapy were excluded.


Disclaimer: This tool is intended for use by healthcare professionals only. Patients with febrile neutropenia should seek medical care urgently. Physicians and other healthcare professionals who use CISNE should exercise their own clinical judgment. This app do not give professional advice. We have cautiously tried to create this app based on real-world data. However, standards and practices in medicine may vary as new information become available and professionals should consult a diversity of medical sources. We tried to provide an estimation of risk for clinically stable patients, but we do not endorse any particular management strategy. In particular we did not developed this tool to reduce the level of supportive care for FN patients, but just for the opposite. Your reliance upon predictions obtained through this app is solely at your own risk. The CISNE model does not rule out the possibility that there may be patients with unusual risk factors who must be taken into consideration.  We do not assume any liability or responsibility for damage or injury (including death) to you or other people from any use of this tool.

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