Baseline low ALT activity is associated with increased long-term mortality after COPD exacerbations

N Lasman,M Shalom,C Avaky,G Berger,E Leibowitz,Y Lifshitz,G Segal,G Saltzman-Shenhav,G Goldhaber,N Turpashvili,D Cohen,A Brom

doi:10.1186/s12890-020-1169-z

Abstract

BackgroundCOPD exacerbations have negative impact on patients’ survival. Several risk factors for grave outcomes of such exacerbations have been descried. Muscle dysfunction and mass loss were shown to impact negatively on prognosis and survival. Low activity of the enzyme ALT (Alanine amino-transferase) in the blood is a known indicator for sarcopenia and frailty, however, no previous studies addressed the association of low ALT amongst patients hospitalized due to COPD exacerbation and long-term survival.MethodsThis is a historic prospective cohort study of patients hospitalized due to acute COPD exacerbation.ResultsIncluded were 232 consecutive COPD exacerbation patients. The median time of follow-up was 34.9 months (IQR 23.13–41.73 months). During this period 104 (44.8%) patients died. All patients were grouped to quartiles according to blood ALT levels (after exclusion of cases considered to have hepatic tissue damage (ALT > 40 IU)). The risk of long-term mortality increased, in a statistically significant manner, amongst patients with low ALT values: the median survival of patients with ALT < 11 IU was 18.5 months only while the median survival for the rest of the study group was not reached. For ALT < 11 IU; 12-16 IU; 17-20 IU and > 21 IU the mortality rates were 69%; 40.9%; 36.3 and 25% respectively (p < 0.001 for comparison of lower quartile with upper three quartiles). The crude hazard ratio for mortality amongst patients with ALT levels lower than 11 IU was 2.37 (95% CI; 1.6–3.5). This increased risk of mortality remained significant after adjustment for age, weight, creatinine, albumin concentration and cardiovascular diseases (HR = 1.83; 95% CI 1.08–3.1, p < 0.05).ConclusionsLow ALT values, a biomarker of sarcopenia and frailty, are associated with poor long-term survival amongst patients hospitalized due to COPD exacerbation.

Highlights

Chronic obstructive pulmonary disease (COPD) exacerbations have negative impact on patients’ survival
Sarcopenia and frailty, two overlapping syndromes, defined as causing increased mortality and frequent hospital admissions, are prime candidates for having a negative impact on COPD exacerbations’ outcomes
In a review published back in 2005, Morley et al [10] stated that COPD is one of the chronic diseases associated with frailty

Summary

Introduction

COPD exacerbations have negative impact on patients’ survival. Several risk factors for grave outcomes of COPD exacerbations have been described: Sakamoto et al [6] performed multivariable logistic regression analysis of over 3000 COPD patients and found that older age and lower body mass index, amongst other patients’ characteristics, are significantly associated with increased risk of in-hospital mortality. Sarcopenia (decreased muscle mass associated with increased risk of hospitalizations, falls and mortality) and frailty (increased tendency to succumb to morbidities, often associated with sarcopenia), two overlapping syndromes, defined as causing increased mortality and frequent hospital admissions, are prime candidates for having a negative impact on COPD exacerbations’ outcomes. Maddocks et al [13] found that frailty affect 25% of all COPD patients and that it is a significant factor for pulmonary rehabilitation failure. They state that pulmonary rehabilitation programs are beneficial for frail, COPD patients, potentially reversing frailty characteristics even with a short-term rehabilitation program

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