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Loss of Life Expectancy by 10 Years or More From Elevated Aspartate Aminotransferase: Finding Aspartate Aminotransferase a Better Mortality Predictor for All-Cause and Liver-Related than Alanine Aminotransferase

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机构： [1]Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China [2]Institute of Population HealthSciences, National Health Research Institutes, Zhunan, Taiwan [3]Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Lukang Town, Taiwan [4]Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan [5]MJ Health Research Foundation, Taipei, Taiwan [6]Center forBiostatistics, Bioinformatics and Big Data, The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China [7]National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China [8]Department of Epidemiology, The University of Texas MDAnderson Cancer Center, Houston, Texas, USA [9]Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, California, USA [10]Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, and Department of Medical Research, China Medical UniversityHospital, Taichung, Taiwan.

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OBJECTIVES:Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are 2 commonly ordered liver function tests, and ALT has long been considered more liver-specific than AST. Between the 2, the one which is better in predicting liver or non-liver-related mortality remains unsettled.METHODS:The cohort, 416,122 adults, came from a self-paying comprehensive health surveillance program during 1994-2008 and was followed up till 2008. Mortality came from National Death Index, with 10,412 deaths identified. Hazard ratios (HRs), computed by Cox model, and life expectancy, by life table method, were presented for 5 levels of AST and ALT with elevated AST or ALT defined as ≥40 IU/L. Liver disease included liver cancer and other liver conditions.RESULTS:There were 3 times more elevated ALT (15.4%) than AST (5.7%). However, those with elevated AST had higher mortality for all-cause (HR = 2.44), for liver disease (HR = 27.2), and for liver cancer (HR = 47.6) than its ALT counterparts (HR = 1.69, 10.8, and 20.2, respectively). Elevated AST also lost more years of life expectancy (10.2) than those lost by ALT (5.2) and larger than most common risks. Elevated AST had increased mortality from all cancers (HR = 3.57), stroke (HR = 1.36), respiratory diseases (HR = 1.34), and injuries (HR = 1.82), other than just liver disease. All-cause mortality remained significantly increased, when high risk groups were excluded, such as frequent drinkers, hepatitis carriers, those died from nonmedical conditions, those died in the first 3 years, or advanced fibrosis index based on 4 factors or aspartate transaminase-to-platelet ratio index. Results were consistent between those returned for second visits and those analyzed in initial visits.DISCUSSION:Those with elevated AST (≥40 IU/L) had life expectancy cut short by 10.2 years, doubled the number of years lost with elevated ALT. For all-cause and for liver-related mortality, AST was an important predictor, better than ALT. © 2019 by The American College of Gastroenterology.

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出版当年[2019]版：

大类 | 1 区

医学

小类 | 1 区胃肠肝病学

最新[2023]版：

大类 | 1 区

医学

小类 | 2 区胃肠肝病学

第一作者：

第一作者机构： [1]Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China

通讯作者：

通讯机构： [2]Institute of Population HealthSciences, National Health Research Institutes, Zhunan, Taiwan [6]Center forBiostatistics, Bioinformatics and Big Data, The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China [7]National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China [8]Department of Epidemiology, The University of Texas MDAnderson Cancer Center, Houston, Texas, USA [10]Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, and Department of Medical Research, China Medical UniversityHospital, Taichung, Taiwan.

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