Serum aminotransferase activity and mortality risk in a United States community

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.)

[1]  N. Seersholm,et al.  Standardised mortality rates in females and males with COPD and asthma , 2005, European Respiratory Journal.

[2]  L. Kurland,et al.  The patient record in epidemiology. , 1981, Scientific American.

[3]  R. Green,et al.  AGA technical review on the evaluation of liver chemistry tests. , 2002, Gastroenterology.

[4]  G. Ellis,et al.  Serum enzyme tests in diseases of the liver and biliary tree. , 1978, American journal of clinical pathology.

[5]  I. Suh,et al.  Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study , 2004, BMJ : British Medical Journal.

[6]  F. Brancati,et al.  The prevalence and etiology of elevated aminotransferase levels in the United States , 2003, American Journal of Gastroenterology.

[7]  F. Wróblewski,et al.  Serum Glutamic Pyruvic Transaminase in Cardiac and Hepatic Disease.∗ , 1956, Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine.

[8]  David Haber,et al.  Guide to clinical preventive services: a challenge to physician resourcefulness , 1993 .

[9]  I. Williams,et al.  Epidemiology of hepatitis C in the United States. , 1999, The American journal of medicine.

[10]  H. Zimmerman,et al.  SERUM ENZYME LEVELS IN THE DIAGNOSIS OF HEPATIC DISEASE. , 1963, The American journal of gastroenterology.

[11]  D. Mozaffarian,et al.  Elevated serum alanine aminotransferase activity and calculated risk of coronary heart disease in the United States , 2006, Hepatology.

[12]  E. Boyko,et al.  The Prevalence and Predictors of Elevated Serum Aminotransferase Activity in the United States in 1999–2002 , 2006, The American Journal of Gastroenterology.

[13]  D. Erickson,et al.  A prospective, high-risk study of the relationship between tobacco dependence and alcohol use disorders. , 1996, Alcoholism, clinical and experimental research.

[14]  L. Melton,et al.  History of the Rochester Epidemiology Project. , 1996, Mayo Clinic proceedings.

[15]  J. Delattre,et al.  Factors associated with serum alanine transaminase activity in healthy subjects: Consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C , 1998, Hepatology.

[16]  C. Stegbauer.  Guide to Clinical Preventive Services , 1990, Journal of the American Osteopathic Association.

[17]  G. Marchesini,et al.  Association of nonalcoholic fatty liver disease with insulin resistance. , 1999, The American journal of medicine.

[18]  T. Ben-Menachem,et al.  Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients , 1999, American Journal of Gastroenterology.

[19]  D S Rae,et al.  Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. , 1990, JAMA.

[20]  J. R. Koehler,et al.  Modern Applied Statistics with S-Plus. , 1996 .

[21]  H. Zeeb,et al.  Causes of death in obesity: relevant increase in cardiovascular but not in all-cancer mortality. , 2006, Journal of clinical epidemiology.

[22]  F. Wróblewski,et al.  Serum glutamic oxalacetic aminopherase (transaminase) in hepatitis. , 1956, Journal of the American Medical Association.

[23]  Rong Wang,et al.  The relationship between alcohol use and cigarette smoking in a sample of undergraduate college students. , 2007, Addictive behaviors.

[24]  H. Brenner,et al.  Elevated liver enzyme activity in construction workers: prevalence and impact on early retirement and all-cause mortality , 1998, International archives of occupational and environmental health.

[25]  F. Wróblewski.  The clinical significance of transaminase activities of serum. , 1959, The American journal of medicine.

[26]  K. Bucholz,et al.  Alcohol and tobacco use disorders in a general population: short-term and long-term associations from the St. Louis epidemiological catchment area study. , 2003, Drug and alcohol dependence.

[27]  J. Dienstag,et al.  Evaluation of blood donors with elevated serum alanine aminotransferase levels. , 1987, Annals of internal medicine.

[28]  Allan F Williams,et al.  Alcohol-impaired driving and its consequences in the United States: the past 25 years. , 2006, Journal of safety research.

[29]  A. Zanella,et al.  Updated Definitions of Healthy Ranges for Serum Alanine Aminotransferase Levels , 2002, Annals of Internal Medicine.