E Ramaty1, E Maor2, N Peltz-Sinvani3, A Brom3, A Grinfeld4, S Kivity5, S Segev6, Y Sidi7, T Kessler3, B A Sela8, G Segal3. 1. Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel. Electronic address: Erez.Ramaty@sheba.health.gov.il. 2. Leviev Heart Institute, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel. 3. Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel. 4. Barzilay Medical Center, Israel. 5. Internal Medicine "C", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel; The Zabludovicz Center for Autoimmune Diseases, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel. 6. Institute of Preventive Medicine, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel. 7. Internal Medicine "C", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel. 8. Institute of Chemical Pathology, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
Abstract
BACKGROUND: Increased blood levels of alanine amino transferase (ALT, also known as SGPT; serum glutamic pyruvic transaminase) serve as a marker of liver injury by various mechanisms. Less is known about the clinical implications associated with low-normal ALT levels. Previous studies showed low ALT levels to be associated with poor long-term outcomes among elderlies, serving as a biomarker for increased incidence of frailty and subsequent risk of mortality. However, it has not been determined yet whether low-normal ALT values might be predictive of frailty and mortality in younger, middle-aged adults. METHODS: We conducted a historical prospective cohort analysis. RESULTS: A total of 23,506 adults with ALT levels within the normal range, at the mean age of 48 ± 11 years, participating in an annual screening program for preventive medicine, were followed-up for a median period of 8.5 years during which 638 died. Low-normal ALT values (serum ALT activity <17IU/L) were found to be predictive for increased risk of all-cause mortality (HR=1.6; 95% CI 1.34-1.92; p<0.001). Statistically significant correlation was demonstrated even after applying a multifactorial model correction for age, gender, eGFR, low albumin, arterial hypertension, diabetes mellitus and ischemic heart disease. CONCLUSIONS: We suggest that low-normal ALT values may serve as an independent predictive marker for increased long-term mortality in middle-aged adults.
BACKGROUND: Increased blood levels of alanine amino transferase (ALT, also known as SGPT; serum glutamic pyruvic transaminase) serve as a marker of liver injury by various mechanisms. Less is known about the clinical implications associated with low-normal ALT levels. Previous studies showed low ALT levels to be associated with poor long-term outcomes among elderlies, serving as a biomarker for increased incidence of frailty and subsequent risk of mortality. However, it has not been determined yet whether low-normal ALT values might be predictive of frailty and mortality in younger, middle-aged adults. METHODS: We conducted a historical prospective cohort analysis. RESULTS: A total of 23,506 adults with ALT levels within the normal range, at the mean age of 48 ± 11 years, participating in an annual screening program for preventive medicine, were followed-up for a median period of 8.5 years during which 638 died. Low-normal ALT values (serum ALT activity <17IU/L) were found to be predictive for increased risk of all-cause mortality (HR=1.6; 95% CI 1.34-1.92; p<0.001). Statistically significant correlation was demonstrated even after applying a multifactorial model correction for age, gender, eGFR, low albumin, arterial hypertension, diabetes mellitus and ischemic heart disease. CONCLUSIONS: We suggest that low-normal ALT values may serve as an independent predictive marker for increased long-term mortality in middle-aged adults.
Authors: Umberto Vespasiani-Gentilucci; Antonio De Vincentis; Luigi Ferrucci; Stefania Bandinelli; Raffaele Antonelli Incalzi; Antonio Picardi Journal: J Gerontol A Biol Sci Med Sci Date: 2018-06-14 Impact factor: 6.053
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