AimFaecal immunochemical testing (FIT) is used in the detection of colorectal cancer (CRC). FIT is invariably used at a single faecal haemoglobin (f‐Hb) concentration threshold. The aim of this observational study was to explore risk scoring models (RSMs) with f‐Hb and other risk factors for CRC in symptomatic patients attending primary care, potentially speeding diagnosis and saving endoscopy resources.MethodRecords of patients completing FIT were linked with The Scottish Cancer Registry and with other databases with symptoms, full blood count and demographic variables, and randomized into derivation and validation cohorts. Stepwise multivariable logistic regression created RSMs assessed in the validation cohort.ResultsOf 18 805 unique patients, 9374 and 9431 were in the derivation and validation cohorts, respectively: f‐Hb, male sex, increasing age, iron deficiency anaemia and raised systemic immune inflammation index created the final RSM. A risk score threshold of ≥2.363, generating the same number of colonoscopies as a f‐Hb threshold of ≥10 μg Hb/g gave improved sensitivity for CRC in both cohorts. A RSM which excluded f‐Hb was used to investigate the effect of raising the f‐Hb threshold from ≥10 to ≥20 μg Hb/g in those with a low risk score. This approach would have generated 234 fewer colonoscopies but missed four CRCs.ConclusionThe RSM conferred no significant benefit to patients with very low f‐Hb and CRC. Alternative strategies combining FIT with other variables may be more appropriate for safety‐netting of symptomatic patients. Further work to develop and investigate the value of RSM for significant bowel disease other than CRC may also be beneficial.

中文翻译：

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风险评分是否会改善初级保健中有症状患者对血红蛋白的粪便免疫化学检测的使用？

AimFaecal 免疫化学检测 (FIT) 用于检测结直肠癌 (CRC)。FIT 总是在单一粪便血红蛋白 (f-Hb) 浓度阈值下使用。这项观察性研究的目的是探索在初级保健的有症状患者中使用 f-Hb 和其他 CRC 危险因素的风险评分模型 (RSM)，从而可能加快诊断速度并节省内窥镜检查资源。方法将完成 FIT 的患者记录与苏格兰医院联系起来癌症登记处和其他数据库提供症状、全血细胞计数和人口统计变量，并随机分为派生和验证队列。逐步多变量逻辑回归创建了在验证队列中评估的 RSM。结果在 18 805 名独特患者中，9374 名和 9431 名分别属于推导队列和验证队列：f-Hb、男性、年龄增加、缺铁性贫血和全身免疫炎症指数升高创建了最终的 RSM。风险评分阈值≥2.363，产生与af-Hb阈值≥10μg Hb/g相同数量的结肠镜检查，提高了两个队列中结直肠癌的敏感性。使用排除 f-Hb 的 RSM 来研究将 f-Hb 阈值从 ≥10 μg Hb/g 提高到 ≥20 μg Hb/g 对低风险评分患者的影响。这种方法可以减少 234 例结肠镜检查，但漏掉了 4 个 CRC。 结论 RSM 对 f-Hb 和 CRC 极低的患者没有显着的益处。将 FIT 与其他变量相结合的替代策略可能更适合有症状患者的安全网。进一步开发和研究 RSM 对 CRC 以外的重大肠道疾病的价值也可能是有益的。