CISNE (Febrile Neurtropenia) Calculator

By Dr. Costa / July 24, 2026

CISNE Calculator

Medical Risk Calculator

Clinical Index of Stable Febrile Neutropenia (CISNE)

Identifies apparently stable adults with solid-tumour febrile neutropenia who are at risk of serious complications.

Confirm eligibility before scoring Use only in adults with solid tumours and apparently stable febrile neutropenia. Do not use when there is acute organ failure, hypotension or septic shock, a known severe infection, decompensated chronic organ insufficiency, or another independent indication for hospital admission.

1. ECOG Performance Status

ECOG PS 2: capable of all self-care, unable to perform work activities, and out of bed for more than 50% of waking hours.

ECOG PS <2 0 points ECOG PS ≥2 +2 points

2. Stress-induced hyperglycaemia

Initial blood glucose ≥121 mg/dL (6.7 mmol/L), or ≥250 mg/dL (13.9 mmol/L) in patients with diabetes or receiving steroids.

No 0 points Yes +2 points

3. Chronic obstructive pulmonary disease (COPD)

COPD diagnosed and treated with at least one of the following: steroids, supplemental oxygen, or bronchodilators.

No 0 points Yes +1 point

4. Cardiovascular disease history

Chronic heart disease such as cor pulmonale, heart failure, cardiomyopathy, hypertensive heart disease, arrhythmia, valvular disease, or another structural abnormality. Exclude a single uncomplicated episode of atrial fibrillation.

No 0 points Yes +1 point

5. NCI mucositis grade ≥2

Painful erythema, oedema, or ulcers, while eating and swallowing remain possible.

No 0 points Yes +1 point

6. Absolute monocyte count

Use the initial absolute monocyte count.

≥200/µL (≥0.2 × 10⁹/L) 0 points <200/µL (<0.2 × 10⁹/L) +1 point

Please answer all six questions before calculating the score.

CISNE score: 0/8

Scoring breakdown

Interpretation guide

Score	Risk class	Approximate serious-complication risk
0	Class I — Low risk	About 1%
1–2	Class II — Intermediate risk	About 6%
3–8	Class III — High risk	About 36%

Clinical safety: Febrile neutropenia is an urgent medical condition. CISNE supplements, but does not replace, clinical assessment, local oncology protocols, microbiology results, observation, or clinician judgement. The score was designed principally to identify apparently stable patients who may be unsafe for early discharge; it should not be used alone to approve outpatient treatment.

CISNE score: 0/8

Scoring breakdown

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