住院患者中谷丙转氨酶（ALT）值低与低血糖风险增加及全因死亡率升高相关：一项对51831例患者的回顾性大数据分析。

Low ALT values amongst hospitalized patients are associated with increased risk of hypoglycemia and overall mortality: a retrospective, big-data analysis of 51 831 patients.

作者信息

Itelman E, Segev A, Ahmead L, Leibowitz E, Agbaria M, Avaky C, Negro L, Shenhav-Saltzman G, Wasserstrum Y, Segal G

机构信息

From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel.

Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel.

出版信息

QJM. 2022 Jan 9;114(12):843-847. doi: 10.1093/qjmed/hcaa219.

DOI:10.1093/qjmed/hcaa219

PMID:32642782

Abstract

BACKGROUND

Sarcopenia and frailty influence clinical patients' outcomes. Low alanine aminotransferase (ALT) serum activity is a surrogate marker for sarcopenia and frailty. In-hospital hypoglycemia is associated, also with worse clinical outcomes.

AIM

We evaluated the association between low ALT, risk of in-hospital hypoglycemia and subsequent mortality.

DESIGN

This was a retrospective cohort analysis.

METHODS

We included patients hospitalized in a tertiary hospital between 2007 and 2019. Patients' data were retrieved from their electronic medical records.

RESULTS

The cohort included 51 831 patients (average age 70.88). The rate of hypoglycemia was 10.8% (amongst diabetics 19.4% whereas in non-diabetics 8.3%). The rate of hypoglycemia was higher amongst patients with ALT < 10 IU/l in the whole cohort (14.3% vs. 10.4%, P < 0.001) as well as amongst diabetics (24.6% vs. 18.8%, P < 0.001). Both the overall and in-hospital mortality were higher in the low ALT group (57.7% vs. 39.1% P < 0.001 and 4.3% vs. 3.2%, P < 0.001). A propensity score matching, after which a regression model was performed, showed that patients with ALT levels < 10 IU/l had higher risk of overall mortality (HR = 1.21, CI 1.13-1.29, P < 0.001).

CONCLUSIONS

Low ALT values amongst hospitalized patients are associated with increased risk of in-hospital hypoglycemia and overall mortality.

摘要

背景

肌肉减少症和衰弱会影响临床患者的预后。血清丙氨酸氨基转移酶（ALT）活性低是肌肉减少症和衰弱的替代标志物。住院期间低血糖也与更差的临床预后相关。

目的

我们评估了低ALT、住院低血糖风险与随后死亡率之间的关联。

设计

这是一项回顾性队列分析。

方法

我们纳入了2007年至2019年在一家三级医院住院的患者。患者数据从其电子病历中获取。

结果

该队列包括51831名患者（平均年龄70.88岁）。低血糖发生率为10.8%（糖尿病患者中为19.4%，非糖尿病患者中为8.3%）。在整个队列中，ALT<10 IU/l的患者低血糖发生率更高（14.3%对10.4%，P<0.001），糖尿病患者中也是如此（24.6%对18.8%，P<0.001）。低ALT组的总体死亡率和住院死亡率均更高（57.7%对39.1%，P<0.001；4.3%对3.2%，P<0.001）。进行倾向评分匹配后，再进行回归模型分析，结果显示ALT水平<10 IU/l的患者总体死亡风险更高（HR = 1.21，CI 1.13 - 1.29，P<0.001）。