title: ASAT/ALAT ratio provides prognostic information independently of Child-Pugh class, gender and age in non-alcoholic cirrhosis.
abstract: OBJECTIVE
  The aspartate amino transferase/alanine amino transferase (ASAT/ALAT) ratio is increased in cirrhosis. Some studies indicate that the ratio may provide prognostic information as well. The purpose of this study was to further elucidate the role of the ASAT/ALAT ratio as a predictor of survival by assessing it together with classical risk factors such as age, gender and Child-Pugh (CP) class in a mixed cohort of patients with cirrhosis.
  
  
  METHODS
  Eighty-nine patients with alcoholic cirrhosis and 81 patients with non-alcoholic cirrhosis treated at Aker University Hospital between 1999 and 2004 were identified retrospectively. Survival data from these patients per August 2006 were retrieved from the Norwegian Death Registry. Clinical and biochemical data at time of diagnosis were assessed as predictors of survival using the Kaplan-Meier method and Cox regression models.
  
  
  RESULTS
  Median ASAT/ALAT ratio was significantly higher in alcoholic cirrhosis (2.42) as compared with non-alcoholic cirrhosis (1.42). In both groups, a ratio above the median was predictive of poor outcome, p=0.024 and p=0.032, respectively. Other significant predictors of death were CP class (p<0.001), clinical decompensation (p<0.001) and age (p=0.001). Cox regression analyses showed that the ASAT/ALAT ratio was a predictor of death independently of CP class, gender and age in non-alcoholic, but not in alcoholic cirrhosis. The estimated increased hazard (risk of dying) in non-alcoholic cirrhosis was 5% (CI: 1-8%) per 0.10 increase in ASAT/ALAT ratio.
  
  
  CONCLUSIONS
  A high ASAT/ALAT ratio is associated with increased mortality in cirrhosis. In non-alcoholic patients the ratio may provide prognostic information independently of classical risk factors.
authors.affiliation: Department of Gastroenterology, Aker University Hospital, University of Oslo, Norway. j.w.haukeland@medisin.uio.no
authors.forename: John W
authors.initials: JW
authors.lastname: Haukeland
authors.forename: Linn T
authors.initials: LT
authors.lastname: Schreiner
authors.forename: Inger
authors.initials: I
authors.lastname: Lorgen
authors.forename: Svein-Oskar
authors.initials: SO
authors.lastname: Frigstad
authors.forename: Christina
authors.initials: C
authors.lastname: Bang
authors.forename: Nils
authors.initials: N
authors.lastname: Raknerud
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Konopski
mesh_terms: D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000145:classification / Q000401:mortality*; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase