Are the systemic inflammatory response syndrome valid in the assessment of febrile neutropenia?

Dear Editor,

We read with interest the review recently published in your journal¹ on the management of infection and febrile neutropenia in the patient with solid cancer. In Figure 1 of the same an action algorithm is proposed for emergency service healthcare attention of patients with febrile neutropenia. In its central section there is a proposal for determination of systemic inflammatory response syndrome (SIRS) or severe sepsis prior to deciding which should be the following steps in the diagnostic and therapeutic process of the febrile neutropenia.

However, we wish to point out that the use of the criteria defined by the systemic inflammatory response syndrome for identifying patients with sepsis has currently diminished for several reasons. Thus, for example, among patients with suspected infection outside of intensive care units, the predictive value of the in-hospital death rate mortality of other tools such as the quick SOFA (which only evaluates the Glasgow scale, systolic blood pressure and heart rate) is statistically superior to that of the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) and the SRIS² itself. There are studies which show that the SRIS criteria lack sensitivity, as they do not determine one in every 8 patients with infection, organ failure and high associated mortality.³ Lastly, these criteria do not possess ideal specificity either, as almost half of hospitalised patients who have no infection develop SRIS criteria at least once during their hospital stay, which demonstrates that its use as a method of detection of sepsis is not overly useful.⁴

As a result, we believe there are better methods than the standard SRIS method for clinical evaluation of patients with febrile neutropenia who present at the emergency services.