title: Using liver enzymes as screening tests to predict mortality risk.
abstract: OBJECTIVE
  Determine the relationship between liver function test results (GGT, alkaline phosphatase, AST, and ALT) and all-cause mortality in life insurance applicants.
  
  
  METHODS
  By use of the Social Security Master Death File, mortality was examined in 1,905,664 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 50,174 deaths observed in this study population. Results were stratified by 3 age/sex groups: females, age <60; males, age <60; and all, age 60+. Liver function test values were grouped using percentiles of their distribution in these 3 age/sex groups, as well as ranges of actual values.
  
  
  RESULTS
  Using the risk of the middle 50% of the population by distribution as a reference, relative mortality observed for GGT and alkaline phosphatase was linear with a steep slope from very low to relatively high values. Relative mortality was increased at lower values for both AST and ALT. ALT did not predict mortality for values above the middle 50% of its distribution.
  
  
  CONCLUSIONS
  GGT and alkaline phosphatase are significant predictors of mortality risk for all values. ALT is still useful for triggering further testing for hepatitis, but AST should be used instead to assess mortality risk linked with transaminases.
authors.affiliation: Clinical Reference Laboratory, Jackson, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fulks
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stout
authors.forename: Vera F
authors.initials: VF
authors.lastname: Dolan