Abstract
Background and aim: Recent practice guidelines suggest healthy normal alanine aminotransferase (ALT) levels should be less than 30 U/L for males and 19 U/L for females. We tried to validate the prediction power of the “low cut off” for liver related outcomes in the general population. Methods: A total of 426,013 subjects were followed up for 10 years using the National Health Screening Cohort database. Prediction ability of long term mortality and liver related outcomes between conventional (<40 U/L in men and women) and low (<30 U/L in men and <19 U/L in women) ALT cut-off values were compared. Results: Both conventional and low ALT cut-offs predicted liver related unfavorable outcomes in Kaplan-Meier analysis. Following adjustment for age, body mass index, smoking, exercise, alcohol consumption, fasting blood glucose, and cholesterol via multivariate Cox regression, abnormal ALT using new ‘low ALT cut off’ was a significant independent predictor for liver-related mortality, HCC, and decompensated liver events. When the low cut-off criteria were added to the prediction model, the ability to predetect liver-related hard outcomes significantly increased in both men and women (p-values < 0.0001). The C-index values for predicting liver-related adverse events were the same in both ALT cut-offs, after adjusting confounding factors (C index value: 0.73~0.88). Conclusions: New low ALT cut-off showed good prediction power for liver related unfavorable outcomes.
Highlights
The alanine aminotransferase (ALT) test has been widely used to screen, detect, and follow up on the status of liver diseases
In our study, when comparing the conventional level for the upper level of normal for ALT (
There was no difference in the C-index values between the conventional and low ALT cut-offs after adjusting for confounding variables
Summary
The alanine aminotransferase (ALT) test has been widely used to screen, detect, and follow up on the status of liver diseases. ULNs of ALT were proposed as 29 U/L in men and 22 U/L in women using the National Health and Nutrition Examination Survey of the United States [2]. In another cross-sectional study, ULNs of ALT in 1105 biopsy-proven healthy liver donors were 33 U/L in men and 25 U/L in women [3]. Prediction ability of long term mortality and liver related outcomes between conventional (
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