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High ALT/AST Increases Mortality
  "Risk of Mortality and Elevated Serum Aminotransferases"
Gastroenterology Feb 2007
Les Lang
published online 3 February 2007.
Richard Peek and K. Rajender Reddy, Section Editors
Elevated serum aminotransferases, such as ALT and AST, may predict mortality in the general population, according to researchers led by W. Ray Kim, MD, Associate Professor of Medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota.
At the American Association for the Study of Liver Diseases (AASLD) 57th Annual Meeting on October 30, 2006, Dr Kim presented data on 18,330 community residents who had AST levels measured at least once in 1995. Of these, 15,991 had normal results and 2339 had elevated AST levels. Also in 1995, 6792 residents had ALT levels measured, and of these, 907 had elevated values.
"Serum concentrations of aminotransferases are commonly used as indicators of liver disease. We evaluated these enzymes as predictors of survival at the population level," Dr Kim and colleagues said. The study found "a significant increase in the standardized mortality ratio with increasing AST and ALT levels, whereas a normal AST or ALT level was associated with a risk of death lower than expected."
To exclude patients with abnormal results because of a terminal illness, deaths within the first 2 years were excluded from the study. Standardized mortality ratio was used to assess the risk of death.
AST levels 2 times the upper limit of normal had a mortality ratio of 1.79 and ALT levels 2 times the upper limit of normal had a mortality ratio of 1.63. The study showed a near-linear relationship between AST and ALT values and subsequent risk of death in both genders, Dr Kim said. "Chronic liver disease is the 10th most common cause of death in the United States. ALT may identify patients at risk of death from liver disease early in their disease."
The researcher suggested that AST and ALT screening be included in the evaluation of patients. "Serum levels of AST and ALT are predictive of future mortality in community populations. These data suggest that screening for abnormal AST or ALT should be considered an important component of the general medical examination." It appears that we are at a stage where we see an analogy between the value of testing for cholesterol in the general population and evaluating for abnormal transaminases.
For further details, see "Serum Aminotransferase Concentrations and Risk of Mortality in a Community Population." AASLD 57th Annual Meeting, October 27-30, 2006; Boston, MA. Abstract #95.
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