Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.
School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
J Gerontol A Biol Sci Med Sci. 2024 Nov 1;79(11). doi: 10.1093/gerona/glae203.
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are commonly ordered tests in general medical practice. However, their distribution and significance in older adults are understudied. As such, we aimed to evaluate sex-stratified distribution of both ALT and AST in older adults (≥70 years) and assess for associations with mortality.
Post-hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized, placebo-controlled trial of daily low-dose aspirin for initially relatively healthy older persons. Univariate analysis and multiple logistic regression were used to explore baseline characteristics. Cox regression and restricted cubic splines were used to examine links between transaminase levels and mortality.
Of the 11 853 participants with ALT and AST levels, 1 054 (8.9%) deaths were recorded over a median of 6.4 (interquartile range [IQR] 5.4-7.6) years. For ALT, the lowest quintiles for males and females were 6-15 and 5-13 U/L, respectively; for AST, the lowest quintiles were 8-18 and 7-17 U/L, respectively. On both univariate and models adjusted for covariates including age, body mass index, frailty, diabetes, and kidney disease, males and females in the lowest quintile of ALT had an increased hazard of mortality (aHR 1.51 [95% confidence interval {CI} 1.14-1.99] and aHR 1.39 [95% CI 1.03-1.88], respectively). For the lowest quintile of AST, only males were at increased risk (aHR 1.33 [95% CI 1.04-1.70]). Associations remained significant when removing outliers.
Low ALT levels independently confer an increased hazard of mortality for older males and females; low AST only affected older male survival. Further evaluation of mechanisms would be worthwhile, and re-evaluating the lower limit of normal for ALT in older adults should be considered.
丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）是一般医疗实践中常用的检测项目。然而，它们在老年人中的分布和意义尚未得到充分研究。因此，我们旨在评估老年（≥70 岁）人群中 ALT 和 AST 的性别分层分布，并评估其与死亡率的相关性。
对阿司匹林减少老年人事件（ASPREE）随机、安慰剂对照试验的事后分析，该试验旨在对最初相对健康的老年人进行每日低剂量阿司匹林治疗。使用单变量分析和多逻辑回归探索基线特征。使用 Cox 回归和限制立方样条检查转氨水平与死亡率之间的联系。
在有 ALT 和 AST 水平的 11853 名参与者中，中位随访 6.4（四分位距 [IQR] 5.4-7.6）年后记录到 1054 例（8.9%）死亡。对于 ALT，男性和女性的最低五分位数分别为 6-15 和 5-13 U/L；对于 AST，最低五分位数分别为 8-18 和 7-17 U/L。在单变量和调整年龄、体重指数、虚弱、糖尿病和肾脏疾病等协变量的模型中，ALT 最低五分位数的男性和女性死亡率的危险度均增加（调整危险比 [aHR] 1.51 [95%置信区间 {CI} 1.14-1.99] 和 aHR 1.39 [95% CI 1.03-1.88]）。对于 AST 的最低五分位数，只有男性的风险增加（aHR 1.33 [95% CI 1.04-1.70]）。当去除离群值时，相关性仍然显著。
低 ALT 水平独立增加了老年男性和女性的死亡风险；低 AST 仅影响老年男性的生存。进一步评估机制将是值得的，并且应该考虑重新评估老年人 ALT 的正常下限。
