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. 2019 Sep 11;8(9):1445.
doi: 10.3390/jcm8091445.

Low Alanine Aminotransferase Cut-Off for Predicting Liver Outcomes; A Nationwide Population-Based Longitudinal Cohort Study

Jin Hwa Park  1 , Jun Choi  2 , Dae Won Jun  3 , Sung Won Han  4 , Yee Hui Yeo  5 , Mindie H Nguyen  6
Affiliations

Low Alanine Aminotransferase Cut-Off for Predicting Liver Outcomes; A Nationwide Population-Based Longitudinal Cohort Study

Jin Hwa Park et al. J Clin Med. .

Abstract

Background and aim: Recent practice guidelines suggest healthy normal alanine aminotransferase (ALT) levels should be less than 30 U/L for males and 19 U/L for females. We tried to validate the prediction power of the "low cut off" for liver related outcomes in the general population.

Methods: A total of 426,013 subjects were followed up for 10 years using the National Health Screening Cohort database. Prediction ability of long term mortality and liver related outcomes between conventional (<40 U/L in men and women) and low (<30 U/L in men and <19 U/L in women) ALT cut-off values were compared.

Results: Both conventional and low ALT cut-offs predicted liver related unfavorable outcomes in Kaplan-Meier analysis. Following adjustment for age, body mass index, smoking, exercise, alcohol consumption, fasting blood glucose, and cholesterol via multivariate Cox regression, abnormal ALT using new 'low ALT cut off' was a significant independent predictor for liver-related mortality, HCC, and decompensated liver events. When the low cut-off criteria were added to the prediction model, the ability to predetect liver-related hard outcomes significantly increased in both men and women (p-values < 0.0001). The C-index values for predicting liver-related adverse events were the same in both ALT cut-offs, after adjusting confounding factors (C index value: 0.73~0.88).

Conclusions: New low ALT cut-off showed good prediction power for liver related unfavorable outcomes.

Keywords: alanine aminotransferase; liver function tests; mortality; upper limit of normal.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient enrollment flow chart.
Figure 2
Figure 2
Multivariate hazard ratios relating alanine aminotransferase levels to liver-related mortality, hepatocellular carcinoma, and decompensated liver events according to Cox regression (adjusted for age, body mass index, smoking, exercise, alcohol consumption, fasting blood glucose, and cholesterol levels): (A) Men and (B) Women.
Figure 3
Figure 3
Kaplan-Meier curves for development of liver outcomes according to alanine aminotransferase levels: (A) Liver-related mortality; (B) hepatocellular carcinoma; and (C) decompensated liver events.
Figure 4
Figure 4
Likelihood ratio of mortality and morbidity and receiver operating characteristic curve according to ALT reference variables: (A,B) Cox proportional hazard regression models for likelihood ratio (LR) for liver outcomes according to two different alanine aminotransferase (ALT) cut-off values. All adjusted for age, BMI, smoking, exercise, alcohol consumption, fasting blood glucose, and cholesterol. LR, likelihood-ratio statistic: ΔG2 = −2 log L from reduced model(−2 log L from current model). Reduced model is the control model. Current model is the cut-off model; (C,D) Optimal cut-off values of alanine aminotransferase for adverse liver outcomes.
See this image and copyright information in PMC

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