title: Elevation of Serum Aminotransferase Levels and Future Risk of Death from External Causes: A Prospective Cohort Study in Korea.
abstract: OBJECTIVE
  The association between liver enzymes and death from external causes has not been examined. We investigated the association between serum aminotransferase levels and external-cause mortality in a large prospective cohort study.
  
  
  METHODS
  A total of 142,322 subjects of 35-59 years of age who completed baseline examinations in 1990 and 1992 were enrolled. Mortalities were identified using death certificates. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were categorized into quintiles. Sub-distribution hazards ratios and 95% confidence intervals (CIs) were estimated using a competing risks regression model in which deaths from other causes were treated as competing risks.
  
  
  RESULTS
  Of 8,808 deaths, 1,111 (12.6%) were due to external causes. Injury accounted for 256 deaths, and suicide accounted for 255. After adjusting for covariates, elevated ALT and AST were significantly associated with an increased risk of all external-cause mortalities, as well as suicide and injury. Sub-distribution hazards ratios (95% CIs) of the highest versus the lowest quintiles of serum ALT and AST were, respectively, 1.57 (1.26-1.95) and 1.45 (1.20-1.76) for all external causes, 2.73 (1.68-4.46) and 1.75 (1.15-2.66) for suicide, and 1.79 (1.10-2.90) and 1.85 (1.21-2.82) for injury. The risk of external-cause mortality was also significantly higher in the fourth quintile of ALT (21.6-27.5 IU/L) than in its first quintile.
  
  
  CONCLUSIONS
  Elevated aminotransferase levels, even within the normal range, were significantly associated with increased risk of all external-cause mortalities, including suicide, and injury.
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jungwoo
authors.initials: J
authors.lastname: Sohn
authors.affiliation: Department of Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Dae Ryong
authors.initials: DR
authors.lastname: Kang
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyeon Chang
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jaelim
authors.initials: J
authors.lastname: Cho
authors.affiliation: Health Insurance Review & Assessment Service, Seoul, Korea.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. preman@yuhs.ac.
authors.forename: Changsoo
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Il
authors.initials: I
authors.lastname: Suh
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood* / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000097:blood* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012306:Risk
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Liver enzymes; cardiovascular disease; external-cause mortality; hepatic disease