Schmilovitz-Weiss Hemda, Gingold-Belfer Rachel, Boltin Doron, Beloosesky Yichayaou, Meyerovitch Joseph, Tor Ruth, Issa Nidal, Grossman Alon, Koren-Morag Nira, Weiss Avraham
Gastroenterology Department.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Gastroenterol Hepatol. 2018 Dec;30(12):1428-1433. doi: 10.1097/MEG.0000000000001225.
Serum alanine aminotransferase (ALT) levels below and above the reference range have been found to serve as a marker of liver injury and to predict all-cause mortality. The need to adjust the reference range by age, sex, or other parameters remains unclear. The current reference range of serum ALT in Israel is 0-34 IU/l for women and 0-45 IU/l for men. We aimed to test the applicability of the current reference range values of ALT in specific people - the elderly population.
A retrospective design was used. The study population consisted of community-dwelling individuals aged at least 65 years who were tested for serum ALT in 2002 at a large health management organization and followed until the end of December 2012. Data were collected on demographics, laboratory tests, comorbidities, and mortality.
A total of 49 634 participants (59% women, mean age 83.2±6.3 years) were included. ALT levels between 16 and 25 IU/l were associated with the lowest mortality (hazard ratio=1), and values of less than 16 IU/l and more than 25 IU/l (unadjusted) were associated with higher mortality risk, yielding a U-shaped pattern.Highest mortality rates were also revealed at serum ALT levels more than 56 IU/l and less than 10 IU/l. A significant association of higher mortality risk was noted with lower mean values of hemoglobin, albumin, and total cholesterol, both for patients with lower serum ALT levels (<10 IU/l) and patients with higher serum levels (>56 IU/l).
Very low and very high levels of serum ALT within the current reference range are associated with an increased risk of death in community-dwelling individuals of at least 65 years old.
血清丙氨酸氨基转移酶（ALT）水平低于和高于参考范围已被发现可作为肝损伤的标志物并预测全因死亡率。是否需要根据年龄、性别或其他参数调整参考范围仍不明确。以色列目前血清ALT的参考范围是女性为0 - 34 IU/L，男性为0 - 45 IU/L。我们旨在测试当前ALT参考范围值在特定人群——老年人群中的适用性。
采用回顾性设计。研究人群包括2002年在一家大型健康管理机构接受血清ALT检测且年龄至少65岁的社区居住个体，并随访至2012年12月底。收集了人口统计学、实验室检查、合并症和死亡率的数据。
共纳入49634名参与者（59%为女性，平均年龄83.2±6.3岁）。ALT水平在16至25 IU/L之间与最低死亡率相关（风险比 = 1），而低于16 IU/L和高于25 IU/L（未调整）的值与较高死亡风险相关，呈现出U形模式。血清ALT水平高于56 IU/L和低于10 IU/L时也显示出最高死亡率。对于血清ALT水平较低（<10 IU/L）和较高（>56 IU/L）的患者，血红蛋白、白蛋白和总胆固醇的较低平均值与较高死亡风险存在显著关联。
在当前参考范围内，血清ALT水平极低和极高与至少65岁社区居住个体的死亡风险增加相关。
