title: Low alanine aminotransferase activity in older people is associated with greater long-term mortality.
abstract: OBJECTIVE
  To find possible association between liver enzymes and mortality in older people.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Jerusalem.
  
  
  METHODS
  A systematically selected representative sample of 455 70-year-old ambulatory individuals was prospectively followed for 12 years.
  
  
  METHODS
  An extensive social and medical profile was developed at age 70 using a detailed interview and physical and ancillary examination. Information on mortality was obtained annually. Differences in survival between subjects stratified according to liver enzyme levels were assessed using the Kaplan-Meier method. Multivariable survival analyses using a Cox proportional hazards model were performed to determine the association between liver enzyme levels at age 70 and mortality over 12 years.
  
  
  RESULTS
  Median alanine aminotransferase (ALT) activity of the study population was 11.00 U/L for women and 13.00 U/L for men. Twelve-year survival rates for women with ALT below and above the median levels were similar (78%). For men, these rates were 54% and 65%, respectively (P < .001). Proportional hazards models demonstrated that this greater mortality risk was independent of numerous common risk factors for mortality (hazard ratio (HR) = 1.5, 95% confidence interval (CI) = 1.08-2.19). Adding an interaction between sex and low ALT to the model demonstrated a higher risk of mortality for men with low ALT levels (HR = 2.42, 95% CI = 1.15-5.08). No such risk was demonstrated for the other liver enzymes.
  
  
  CONCLUSIONS
  ALT activity represents a strong and independent surrogate marker for mortality in community-dwelling elderly men.
authors.affiliation: Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus Campus, Jerusalem, Israel. eelina97@md.huji.ac.il
authors.forename: Eran
authors.initials: E
authors.lastname: Elinav
authors.forename: Zvi
authors.initials: Z
authors.lastname: Ackerman
authors.forename: Yoram
authors.initials: Y
authors.lastname: Maaravi
authors.forename: Iddo Z
authors.initials: IZ
authors.lastname: Ben-Dov
authors.forename: Eliana
authors.initials: E
authors.lastname: Ein-Mor
authors.forename: Jochanan
authors.initials: J
authors.lastname: Stessman
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D015992:Body Mass Index; D005260:Female; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D008099:Liver / Q000201:enzymology*; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase