Fecal hemoglobin concentration is useful for risk stratification of advanced colorectal neoplasia

Background: Although a fecal immunochemical test (FIT) allows quantitation of fecal hemoglobin (f-Hb), it is typically used as a binary result to identify subjects above a predetermined cut-off concentration. Aims: To investigate whether f-Hb concentration is useful for risk stratification of advanced colorectal neoplasia (CRN). Methods: This was a retrospective study conducted in a university hospital in Korea. Of 34,547 participants who underwent FIT from June 2013 to May 2015, 1532 (4.4%) showed positive results (>= 100 ng Hb/ml). Of participants with positive results, 738 subjects aged >= 50 years who underwent colonoscopy were analyzed. Results: Increasing quartile of f-Hb concentration (Q4 vs. Q1; odds ratio, 3.87; 95% confidence interval, 2.36-6.34), as well as older age, male sex, smoking, and metabolic syndrome (MetS), was significantly associated with a higher prevalence of advanced CRN. Risk for advanced CRN increased 5.13-, 4.27-, 5.12-, and 7.15-fold, respectively, among individuals with f-Hb in the fourth quartile who had risk factors such as age >= 70 years, male sex, smoking, and MetS compared with individuals with first quartile levels of f-Hb who did not have those risk factors. Conclusion: In addition to age, sex, smoking status, and MetS, f-Hb concentration in individuals with positive results from FIT can be used to stratify the probability of detection of advanced CRN. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.