Lowering the upper limit of serum alanine aminotransferase levels may reveal significant liver disease in the elderly

Abstract

This study sought to determine the prevalence of significant liver disease in those subjects with serum alanine aminotransferase levels in the range between the current and the newly suggested upper limit of normal (termed the delta range). The files of the previous study subjects (who underwent at least one alanine aminotransferase measurement in 2002 and followed to 2012) were reviewed for a diagnosis of chronic liver disease; aspartate aminotransferase/platelet ratio index, FIB-4 and alanine aminotransferase/aspartate aminotransferase ratio were used to evaluate liver fibrosis. The prevalence of significant liver disease, by diagnoses and fibrosis scores was compared between subjects with alanine aminotransferase levels in the delta range (men, 42–45 IU/L; women, 26–34 IU/L) and in the newly suggested normal range (men, 15–42 IU/L; women, 10–26 IU/L). The cohort included 49,634 subjects (41% male, mean age 83±6 years) of whom 2022 were diagnosed with chronic liver disease including 366 with cirrhosis. Compared to subjects with alanine aminotransferase levels in the newly suggested normal range, subjects with alanine aminotransferase levels in the delta range had a significantly higher rate of chronic liver disease (men, 15.3% vs. 4.9%; women, 7.8% vs. 3.3%) and of cirrhosis specifically (men, 4.2% vs. 0.9%; women, 1.5% vs. 0.4%) and also had higher mean fibrosis scores (P <0.001 for all). Lowering the current upper limit of normal of serum alanine aminotransferase may help to identify elderly patients at risk of significant liver disease.

A novel prognostic nomogram for older patients with acute-on-chronic liver diseases (AoCLD): a nationwide, multicentre, prospective cohort study

“…Thus, decreasing liver transaminase in aged livers may lead to these conditions during ageing in response to diseases. Moreover, older individuals who meet the currently accepted normal range of ALT may harbour clinically significant liver disease [ 35 ]. Low ALT activity in older people is associated with greater mortality [ 36 ].…”

Is The Serum Creatinine / Alanine Transaminase Ratio A Predictor Of Mortality In Elderly Patients With Acute Ischemic Stroke?

“…Although the highest tissue concentration of alanine transaminase (ALT) activity is in the cytosol of hepatocytes, it is found throughout the human body, in the kidney, myocardium, skeletal muscle, brain, pancreas, spleen, and lung [3]. It has been reported that lowering the normal value of alanine transaminase (ALT), whose blood value is 15-42 IU/L for men and 10-26 IU/L for women, is bene cial in diagnosing liver diseases in elderly patients, and this value is associated with mortality [4,5].…”