title: Prognostic value of serum liver enzymes levels in type 2 diabetic patients.
abstract: BACKGROUND
  Elevated liver enzymes are associated with cardiovascular disease, while their relationship with cancer-related mortality has not been assessed so far in diabetic patients.
  
  
  METHODS
  An observational cohort study was performed on a consecutive series of 1952 type 2 diabetic patients. The association of liver enzymes with all-cause and cause-specific mortality was assessed. Information on all-cause mortality was obtained by the City of Florence Registry Office.
  
  
  RESULTS
  The average duration of follow-up was 6.4 +/- 2.7 years. Over that period, 362 deaths were recorded (26.9%), with a yearly mortality rate of 4.2%. Age- and sex-adjusted HR of all-cause mortality for gamma glutamyl-transpeptidase (gamma-GT) gamma-GT > 40 U/l was 1.610 [1.245-2.082]. An increased cardiovascular mortality rate was observed in patients with elevation of gamma-GT, and gamma-GT and/or alanine aminotransferase (ALT), when compared with the rest of the sample (15.3 vs 10.8%, p < 0.05; and 15.2 vs 10.7%, p < 0.05, respectively). Similar results were observed when considering cancer-related mortality. The association of higher gamma-GT levels with all-cause, cardiovascular, and cancer-related mortality was confirmed at a multivariate analysis after adjustment for potential confounders.
  
  
  CONCLUSIONS
  The present study shows that, in type 2 diabetic patients, higher gamma-GT, but not ALT, is associated with increased mortality for cardiovascular disease and malignancies.
authors.affiliation: Department of Critical Care Medicine and Surgery, Geriatric Medicine, University of Florence, Florence, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.forename: Caterina
authors.initials: C
authors.lastname: Lamanna
authors.forename: Cecilia
authors.initials: C
authors.lastname: Melani
authors.forename: Carmen
authors.initials: C
authors.lastname: Cocca
authors.forename: Elena
authors.initials: E
authors.lastname: Lotti
authors.forename: Angela
authors.initials: A
authors.lastname: Fedeli
authors.forename: Giulio
authors.initials: G
authors.lastname: Masotti
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000201:enzymology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000201:enzymology* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000201:enzymology / Q000453:epidemiology / Q000401:mortality; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D008099:Liver / Q000201:enzymology*; D008875:Middle Aged; D009369:Neoplasms / Q000201:enzymology / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D005723:gamma-Glutamyltransferase / Q000378:metabolism*
chemical_list: D000410:Alanine Transaminase; D015415:Biomarkers; D006442:Glycated Hemoglobin; D008055:Lipids; D005723:gamma-Glutamyltransferase