Department of Internal Medicine, Hanshan People's Hospital in Anhui Province, Ma'anshan, 238101, Anhui Province, China.
Department of Proctology, Hanshan Hospital of Traditional Chinese Medicine in Anhui Province, Ma'anshan, 238101, Anhui Province, China.
BMC Public Health. 2024 Nov 27;24(1):3302. doi: 10.1186/s12889-024-20773-6.
The liver plays critical roles in human health. Circulating level of liver function biomarkers may associate with the long-term and short-term mortality in general population.
We used data from US National Health and Nutrition Examination Survey 1988-94 and 1999-2014. People aged ≥ 20 years with measured serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), total bilirubin (TB), and albumin (ALB) at baseline were included. All-cause and cause-specific mortality was identified from the National Death Index through 31 December 2015. Additive Cox regression models were applied to assess the correlation patterns between the serum level of these analytes and mortality risk.
A total of 44,508 participants were included; among them, 9,721 deaths occurred during a mean follow-up of 12.5 years. A "J-shaped" correlation was found between serum levels of ALT, AST, and TB and all-cause mortality. The risk of mortality monotonically increased with increasing GGT and ALP levels when their levels exceeded the valley points. A "L-shaped" correlation was found between the serum level of ALB and all-cause mortality. The correlation patterns were comparable among deaths from different causes and were consistent in subgroup and sensitivity analyses. While the integration of all six liver function biomarkers did not yield an optimal predictive performance for mortality (area under ROC curve = 0.706), it demonstrated a significantly better performance compared to any single biomarker..
Circulating liver function biomarkers showed diverse nonlinear correlations with mortality and may be utilized as part of a screening process to help identify individuals who may be at elevated risk of mortality.
肝脏在人体健康中起着至关重要的作用。肝功能生物标志物的循环水平可能与一般人群的长期和短期死亡率相关。
我们使用了美国国家健康和营养调查 1988-94 年和 1999-2014 年的数据。将基线时测量到血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）、总胆红素（TB）和白蛋白（ALB）水平的年龄≥20 岁的人群纳入研究。通过国家死亡索引，截至 2015 年 12 月 31 日，确定全因和特定原因死亡率。应用加性 Cox 回归模型评估这些分析物血清水平与死亡率风险之间的相关模式。
共纳入 44508 名参与者；其中，在平均 12.5 年的随访期间发生了 9721 例死亡。ALT、AST 和 TB 的血清水平与全因死亡率之间存在“J 形”相关关系。当 GGT 和 ALP 水平超过谷值点时，死亡率随着其水平的增加而单调增加。ALB 的血清水平与全因死亡率之间存在“L 形”相关关系。这些关联模式在不同死因的死亡中具有可比性，并且在亚组和敏感性分析中也是一致的。虽然整合所有六种肝功能生物标志物并未对死亡率产生最佳的预测性能（ROC 曲线下面积=0.706），但与任何单一生物标志物相比，其表现明显更好。
循环肝功能生物标志物与死亡率呈不同的非线性相关关系，可作为筛选过程的一部分，以帮助识别可能处于较高死亡率风险的个体。
