title: Fecal hemoglobin concentration is useful for risk stratification of advanced colorectal neoplasia.
abstract: 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.
  
  
  OBJECTIVE
  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 (≥100ng 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Nam Hee
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun-Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Taeheon
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seok Hyeon
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyuyong
authors.initials: K
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: ys810.jung@samsung.com.
authors.forename: Yoon Suk
authors.initials: YS
authors.lastname: Jung
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009780:Occult Blood; D016017:Odds Ratio; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D006454:Hemoglobins
keywords: Advanced colorectal neoplasia; Quantitative fecal immunochemical test; Risk factors