Nakajima Kei, Yuno Mariko, Tanaka Kazumi, Nakamura Teiji
School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, 1-10-1 Heisei-cho, Yokosuka 238-8522, Japan.
Saitama Medical Center, Department of Endocrinology and Diabetes, Saitama Medical University, 1981 Kamoda, Kawagoe 350-8550, Japan.
Healthcare (Basel). 2022 Apr 2;10(4):674. doi: 10.3390/healthcare10040674.
Low serum alanine aminotransferase (ALT) activity and high aspartate aminotransferase (AST)/ALT ratio may be associated with high mortality in the elderly. We aimed to confirm this in an 8-year retrospective cohort study. Clinical data for 5958 people living in a city aged 67−104 years were analyzed for their relationships with all-cause mortality using artificial intelligence (AI) and conventional statistical analysis. In total, 1413 (23.7%) participants died during the study. Auto-AI analysis with five rounds of cross-validation showed that AST/ALT ratio was the third-largest contributor to mortality, following age and sex. Serum albumin concentration and body mass index were the fourth- and fifth-largest contributors. However, when serum ALT and AST were individually considered in the same model, the individual serum ALT and AST activities were the seventh- and tenth-largest contributors. Conventional survival analysis showed that ALT, AST, and AST/ALT ratio as continuous variables were all associated with mortality (adjusted hazard ratios (95% confidence intervals): 0.98 (0.97−0.99), 1.02 (1.02−1.03), and 1.46 (1.32−1.62), respectively; all p < 0.0001). In conclusion, both AI and conventional analysis suggest that of the conventional biochemical markers, high AST/ALT ratio is most closely associated with all-cause mortality in the elderly.
血清丙氨酸氨基转移酶（ALT）活性低和天冬氨酸氨基转移酶（AST）/ALT比值高可能与老年人的高死亡率相关。我们旨在通过一项为期8年的回顾性队列研究来证实这一点。对5958名年龄在67 - 104岁的城市居民的临床数据进行分析，使用人工智能（AI）和传统统计分析方法研究其与全因死亡率的关系。在研究期间，共有1413名（23.7%）参与者死亡。经过五轮交叉验证的自动AI分析表明，AST/ALT比值是导致死亡率的第三大因素，仅次于年龄和性别。血清白蛋白浓度和体重指数分别是第四和第五大因素。然而，当在同一模型中单独考虑血清ALT和AST时，个体血清ALT和AST活性分别是第七和第十大因素。传统生存分析表明，作为连续变量的ALT、AST和AST/ALT比值均与死亡率相关（调整后的风险比（95%置信区间）分别为：0.98（0.97 - 0.99）、1.02（1.02 - 1.03）和1.46（1.32 - 1.62）；所有p < 0.0001）。总之，AI和传统分析均表明，在传统生化标志物中，高AST/ALT比值与老年人的全因死亡率关系最为密切。
