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AASLD: Elevated Liver Enzymes Predict Higher Mortality Risk for All


BOSTON -- High liver enzyme levels are predictive of a greater risk of death within a decade for anyone in the community at large, researchers reported here.

BOSTON, Oct. 30 -- High liver enzyme levels are predictive of a greater risk of death within a decade for anyone in the general population, researchers reported here.

Looking at all residents in their community who had serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) measured in 1995, W. Ray Kim, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues, found that there was an almost linear relationship between aminotransferase levels and standardized mortality risk 10 years later.

"We were pleased to find that our hypothesis seems to be correct, that patients with elevated aminotransferase levels had higher mortality compared to age- and gender-matched population controls," said Dr. Kim at the American Association for the Study of Liver Diseases meeting here.

"These data suggest that screening for abnormal AST or ALT should be considered as an important component of general medical examination," he added.

The Mayo group examined records for all community residents who had their liver enzymes measured in 1995, and followed them forward. They excluded deaths that occurred within the first two years to prevent potential bias of the results from patients who were terminally ill at baseline. They used standardized mortality ratios to assess the risk of death.

A total of 18,330 community resident had their AST levels measured at least once in 1995, and of these, 2,339 had results above the upper limit of normal. Of the 6,792 who had ALT levels taken in 1995, 907 had results above the upper limit of normal.

They found that for those residents with AST above the upper limit of normal, the standardized mortality ratio was 1.33, compared with 0.95 for those with normal levels (P<0.01). For those with AST more than twice the upper limit, the death risk was 1.79 (P<0.01). For the majority of patients who did not have AST levels done (28,688), the mortality risk was 0.79 (P<0.01).

Similarly, for those patients who had ALTs measured, the risk for death among those with normal levels was 0.61, compared with 1.22 for those with levels above the upper limit of normal (P<0.22) and 1.63 for those with levels greater than two times the upper limit of normal (P<0.01). Patients with no ALT levels measured had a slight decrease in mortality risk (0.93, P<0.01).

When they plotted the relationship between aminotransferase levels and death, they found an almost linear relationship, the authors said.

"ALT is not only a marker of liver disease in general, but also that of the metabolic syndrome, " said Dr. Kim. He noted that his group plans to look into the mechanism linking liver enzyme elevations and mortality risk.

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