PURPOSE: This study aimed to determine whether procalcitonin-to-albumin ratio (PAR) and C-reactive protein-to-albumin ratio (CAR) can be alternatives to the Multinational Association for Supportive Care in Cancer (MASCC) risk index score in predicting bacteriemia, septicemia, death during FN, and 28-day mortality, in patients with febrile neutropenia (FN). METHODS: This is a prospective observational study that included 185 participants with FN. Clinical and laboratory findings like PAR and CAR were analyzed, and their ability to predict FN complications was investigated. RESULTS: From the included population, the 91 subjects (49.46%) had low-risk FN with MASCC risk index ≥ 21. Sixteen participants (8.70%) had bacteremia, and eight developed septicemia (4.89%). Before resolving FN, 15 people died, and in total 33 died within 28 days of diagnosis. The ROC curve analysis indicates that the CAR (p = 0.0008921) better predicts mortality during FN, and the PAR (p = 0.0003535) better predicts bacteremia. Incorporating CAR values into the MASCC risk index predicts mortality by as much as 33.33% more precisely than the MASCC risk index alone. The CAR values >
2.74 were an independent predictor of 28-day mortality (OR = 3.70
95% CI = 1.08-13.02
p = 0.0376). CONCLUSION: The study results suggest that PAR and CAR can be leveraged as valuable prognostic tools in predicting bacteremia, septicemia, mortality during FN, and 28-day mortality in patients with FN.