Department of Surgery, Odense University Hospital, 5000, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark.
BMC Med. 2023 Jan 24;21(1):29. doi: 10.1186/s12916-022-02724-3.
Colorectal cancer (CRC) screening reduces all-cause and CRC-related mortality. New research demonstrates that the faecal haemoglobin concentration (f-Hb) may indicate the presence of other serious diseases not related to CRC. We investigated the association between f-Hb, measured by a faecal immunochemical test (FIT), and both all-cause mortality and cause of death in a population-wide cohort of screening participants.
Between 2014 and 2018, 1,262,165 participants submitted a FIT for the Danish CRC screening programme. We followed these participants, using the Danish CRC Screening Database and several other national registers on health and population, until December 31, 2018. We stratified participants by f-Hb and compared them using a Cox proportional hazards regression on all-cause mortality and cause of death reported as adjusted hazard ratios (aHRs). We adjusted for several covariates, including comorbidity, socioeconomic factors, demography and prescription medication.
We observed 21,847 deaths in the study period. Our multivariate analyses indicated an association relationship between increasing f-Hb and the risk of dying in the study period. This risk increased steadily from aHR 1.38 (95% CI: 1.32, 1.44) in those with a f-Hb of 7.1-11.9 μg Hb/g faeces to 2.20 (95% CI: 2.10, 2.30) in those with a f-Hb ≥60.0 μg Hb/g faeces, when compared to those with a f-Hb ≤7.0 μg Hb/g faeces. The pattern remained when excluding CRC from the analysis. Similar patterns were observed between incrementally increasing f-Hb and the risk of dying from respiratory disease, cardiovascular disease and cancers other than CRC. Furthermore, we observed an increased risk of dying from CRC with increasing f-Hb.
Our findings support the hypothesis that f-Hb may indicate an elevated risk of having chronic conditions if causes for the bleeding have not been identified. The mechanisms still need to be established, but f-Hb may be a potential biomarker for several non-CRC diseases.
结直肠癌（CRC）筛查可降低全因死亡率和 CRC 相关死亡率。新的研究表明，粪便血红蛋白浓度（f-Hb）可能表明存在与 CRC 无关的其他严重疾病。我们在一项广泛的筛查参与者人群队列中研究了粪便免疫化学测试（FIT）测量的 f-Hb 与全因死亡率和死因之间的关系。
在 2014 年至 2018 年期间，1262165 名参与者提交了丹麦 CRC 筛查计划的 FIT。我们使用丹麦 CRC 筛查数据库和其他几个关于健康和人口的国家登记册，在 2018 年 12 月 31 日之前对这些参与者进行了随访。我们按 f-Hb 分层，并使用 Cox 比例风险回归比较了所有原因死亡率和死因报告的调整后的危险比（aHR）。我们调整了几个协变量，包括合并症、社会经济因素、人口统计学和处方药物。
在研究期间，我们观察到 21847 例死亡。我们的多变量分析表明，f-Hb 升高与研究期间死亡的风险存在关联关系。这种风险从 f-Hb 为 7.1-11.9μgHb/g 粪便的参与者的 aHR 1.38（95%CI：1.32，1.44）稳步增加到 f-Hb≥60.0μgHb/g 粪便的参与者的 2.20（95%CI：2.10，2.30），与 f-Hb≤7.0μgHb/g 粪便的参与者相比。当从分析中排除 CRC 时，该模式仍然存在。在 f-Hb 逐渐增加与死于呼吸疾病、心血管疾病和除 CRC 以外的癌症的风险之间也观察到类似的模式。此外，我们还观察到 f-Hb 升高与 CRC 死亡风险增加有关。
我们的研究结果支持了这样一种假设，即如果未确定出血原因，f-Hb 可能表明患有慢性疾病的风险增加。其机制仍需建立，但 f-Hb 可能是几种非 CRC 疾病的潜在生物标志物。
