Elevated Serum Alanine Aminotransferase and γ-Glutamyltransferase and Mortality in the United States Population
Received 21 April 2008; accepted 9 October 2008. published online 30 October 2008.
Background & Aims
Elevated serum alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) activities are markers of liver injury, but may also be associated with other diseases and death. In a prospective, national, population-based sample, we examined whether elevated ALT and GGT were associated with increased risk of all-cause and disease-specific mortality.
Methods
Death certificate–based 12-year mortality was analyzed among 14,950 adult participants in the third US National Health and Nutrition Examination Survey, 1988–1994, who were negative for markers of viral hepatitis B and C. Abnormal ALT was defined as >30 U/L in men or >19 U/L in women, and abnormal GGT as >51 U/L in men or >33 U/L in women.
Results
Cumulative mortality was 13.9% from all causes, including 4.2% from cardiovascular disease, 4.2% from neoplasms, 0.44% from diabetes, and 0.13% from liver disease. In multivariate-adjusted analyses, elevated ALT was not associated with all-cause mortality (hazard ratio [HR], 1.2; 95% confidence interval [CI], 0.88–1.6). ALT elevation was associated with deaths from liver disease (HR, 8.2; 95% CI, 2.1–31.9), but not from cardiovascular disease (HR, 0.90; 95% CI, 0.56–1.4), neoplasms (HR, 1.0; 95% CI, 0.65–1.5), or diabetes (HR, 2.4; 95% CI, 0.65–9.1). All-cause mortality increased with elevated GGT (HR, 1.5; 95% CI, 1.2–1.8), as did mortality from liver disease (HR, 13.0; 95% CI, 2.4–71.5), neoplasms (HR, 1.5; 95% CI, 1.01–2.2), and diabetes (HR, 3.3; 95% CI, 1.4–7.6), but not from cardiovascular disease (HR, 1.3; 95% CI, 0.80–2.0).
Conclusions
In the US population, elevated GGT was associated with mortality from all causes, liver disease, cancer, and diabetes, while ALT was associated only with liver disease mortality.
‡National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
Address requests for reprints to: Constance E. Ruhl, MD, PhD, Social & Scientific Systems, Inc, 8757 Georgia Avenue, 12th floor, Silver Spring, Maryland 20910. Phone: (301) 628-3272; fax: (301) 628-3201
Supported by a contract from the National Institute of Diabetes and Digestive and Kidney Diseases (HHSN267200700001G).
ABSTRACT
Elevated Serum Alanine Aminotransferase and γ-Glutamyltransferase and Mortality in the United States Population