Abstract
ObjectiveControversy exists in using alanine aminotransferase (ALT) activity for predicting long-term survival. Therefore, this research study investigated the association between ALT activity and mortality through a systematic review and meta-analysis of previous prospective studies.MethodsElectronic literature databases, including PubMed, Embase, and the Institute for Scientific Information (ISI), were searched for relevant prospective observational studies (published before Dec 30, 2013) on the association between baseline ALT activity and ensuing all-cause/disease-specific mortality. Information on nationality, sample size, participant characteristics, follow-up duration, comparison, outcome assessment, hazard ratios (HRs) and adjusted covariates was extracted. Pooled HRs and corresponding 95% confidence intervals (CIs) were separately calculated for categorical risk estimates (highest vs. lowest ALT categories) and continuous risk estimates (per 5 U/l of ALT increment) in subgroups separated by age (<70/≥70 years).ResultsA total of twelve prospective cohort studies, totaling 206,678 participants and 16,249 deaths, were identified and analyzed. In the younger age group, the pooled HR for mortality related to liver-disease was about 1.24 (95% CI: 1.23–1.25) per 5 U/l of ALT increment. The dose-response HRs of all-cause mortality, cardiovascular (CV) disease-related mortality, and cancer-related mortality were 0.91 (0.88–0.94), 0.91 (0.85–0.96), 0.92 (0.86–0.98) respectively per 5 U/l of ALT elevation, with insignificant heterogeneity in the older population. There was an approximate decrease of 4‰ observed on HRs of all-cause, CV-related, and cancer-related mortality followed with one year's increment through meta-regression (all P<0.05).ConclusionsThe ALT-mortality association was inconsistent and seems particularly susceptible to age after synthesizing the previous prospective studies. In terms of the age, ALT activity was more valuable in predicting mortality in the older population; extremely low ALT levels indicated a higher all-cause, CV-related, and cancer-related mortality. ALT activity may therefore be a useful biomarker when predicting the long-term survival of elderly patients.
Highlights
Measurements of serum alanine aminotransferase (ALT) activity is an available and low-cost biochemical assay in annual health check-ups
The elevated ALT activity was potentially indicative of unrecognized liver disease that especially caused deaths in populations with a high prevalence of viral hepatitis [3]
On the other hand, elevated ALT activity was a potential predictor of CV disease that might add to a risk of death through the metabolic syndrome (MetS) [6,7]
Summary
Measurements of serum alanine aminotransferase (ALT) activity is an available and low-cost biochemical assay in annual health check-ups. On the other hand, elevated ALT activity was a potential predictor of CV disease that might add to a risk of death through the metabolic syndrome (MetS) [6,7]. These associations have been inconsistent and controversial as some prospective studies have failed to observe a significant association between ALT activity and mortality [8,9,10,11,12,13,14]
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