title: Low ALT blood levels predict long-term all-cause mortality among adults. A historical prospective cohort study.
abstract: BACKGROUND
  Increased blood levels of alanine amino transferase (ALT, also known as SGPT; serum glutamic pyruvic transaminase) serve as a marker of liver injury by various mechanisms. Less is known about the clinical implications associated with low-normal ALT levels. Previous studies showed low ALT levels to be associated with poor long-term outcomes among elderlies, serving as a biomarker for increased incidence of frailty and subsequent risk of mortality. However, it has not been determined yet whether low-normal ALT values might be predictive of frailty and mortality in younger, middle-aged adults.
  
  
  METHODS
  We conducted a historical prospective cohort analysis.
  
  
  RESULTS
  A total of 23,506 adults with ALT levels within the normal range, at the mean age of 48 ± 11 years, participating in an annual screening program for preventive medicine, were followed-up for a median period of 8.5 years during which 638 died. Low-normal ALT values (serum ALT activity <17IU/L) were found to be predictive for increased risk of all-cause mortality (HR=1.6; 95% CI 1.34-1.92; p<0.001). Statistically significant correlation was demonstrated even after applying a multifactorial model correction for age, gender, eGFR, low albumin, arterial hypertension, diabetes mellitus and ischemic heart disease.
  
  
  CONCLUSIONS
  We suggest that low-normal ALT values may serve as an independent predictive marker for increased long-term mortality in middle-aged adults.
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel. Electronic address: Erez.Ramaty@sheba.health.gov.il.
authors.forename: E
authors.initials: E
authors.lastname: Ramaty
authors.affiliation: Leviev Heart Institute, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Maor
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Peltz-Sinvani
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Brom
authors.affiliation: Barzilay Medical Center, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Grinfeld
authors.affiliation: Internal Medicine "C", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel; The Zabludovicz Center for Autoimmune Diseases, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Kivity
authors.affiliation: Institute of Preventive Medicine, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Segev
authors.affiliation: Internal Medicine "C", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Sidi
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Kessler
authors.affiliation: Institute of Chemical Pathology, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: B A
authors.initials: BA
authors.lastname: Sela
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Segal
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011446:Prospective Studies
chemical_list: D000410:Alanine Transaminase
keywords: ALT; Frailty; Mortality; SGPT; Screening; Survival