Serum aminotransferase activity and mortality risk in a United States community

Abstract

Serum aminotransferase [such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] is commonly used as an indicator of liver disease. The aim of the study was to determine the degree to which aminotransferase results are associated with increased mortality at the population level. All adult residents of Olmsted County, Minnesota, who had a health care encounter at Mayo Clinic, Rochester, in 1995 were identified and their AST or ALT results extracted from a laboratory database. These subjects were followed forward from January 1995 to April 2006 and their survival determined. To exclude patients with abnormal results because of a terminal illness, deaths within the first 2 years were excluded. The main outcome measure was survival. Standardized mortality ratios (SMRs) were calculated, based on Minnesota White death rates. During 1995, AST was measured at least once in 18,401 community residents, of whom 2,350 (13%) had results greater than the upper limit of normal (ULN). Of 6,823 subjects who had their ALT measured, 911 (13%) had results higher than ULN. Abnormal AST was associated with a significantly increased SMR (1.32 for 1-2؋ ULN and 1.78 for >2؋ ULN). SMR was also higher for abnormal ALT (SMR ‫؍‬ 1.21 for 1-2؋ ULN and 1.51 for >2؋ ULN). In contrast, normal AST or ALT was associated with a risk of death lower than expected (SMR 0.95 for AST, 0.61 for ALT). Conclusion: Serum levels of AST and ALT obtained in a routine medical care setting are associated with future mortality in community residents. (HEPATOLOGY 2008;47:880-887.)

Treatment recommendations for chronic hepatitis B

“…In patients with liver disease, elevated ALT levels may be related to sex (higher in men), body mass, metabolic syndrome, nonalcoholic steatohepatitis, chronic alcohol consumption, or co-existing hepatitis C infection and may be associated with increase mortality risk. 26,29 In our patients herein, we excluded HBsAg-positive patients who had co-existing liver disease such as alcoholic liver disease, autoimmune hepatitis, hemochromatosis, nonalcoholic steatohepatitis, and chronic HCV infection. However, most patients with chronic hepatitis B will experience viral and biochemical flares that result in increases in the serum ALT and aspartate aminotransferase values.…”

Metabolic and histological features of non‐alcoholic fatty liver disease patients with different serum alanine aminotransferase levels

“…In population studies, high ALT level is associated with increased risk of liver-related and cardiovascular mortality. 10,11 On the other hand, it remains unclear how clinicians should interpret ALT results in NAFLD patients. First, the normal range of ALT is derived from healthy subjects in the general population.…”

Advances in Pediatric Nonalcoholic Fatty Liver Disease

“…NAFLD and cardiovascular disease risk factors: Elevated serum ALT (or suspected fatty liver disease) is associated with increased risk of cardiovascular and all-cause mortality (in addition to liver mortality) in adults (34). A case-control study from our group showed that children with biopsy proven NAFLD were more likely to have dyslipidemia, hypertension, insulin resistance, and more components of metabolic syndrome than age-sex-BMI matched controls without NAFLD (35).…”