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Loss of Life Expectancy by 10 Years or More From Elevated Aspartate Aminotransferase

Finding Aspartate Aminotransferase a Better Mortality Predictor for All-Cause and Liver-Related than Alanine Aminotransferase

Xie, Kunlin MD, PhD1; Chen, Chien-Hua MD2–4; Tsai, Shan-Pou PhD5; Lu, Po-Jung PhD2; Wu, Hong MD1; Zeng, Yong MD1; Ye, Yuanqing PhD6–8; Tu, Huakang PhD8; Wen, Christopher MD9; Huang, Maosheng MD8; Zhang, Yajie MD, PhD8; Lee, Jun-Han PhD2; Tsai, Min-Kuang MS2; Wen, Chi-Pang MD, DrPH2,10; Wu, Xifeng MD, PhD6–8

American Journal of Gastroenterology: September 2019 - Volume 114 - Issue 9 - p 1478–1487
doi: 10.14309/ajg.0000000000000332

OBJECTIVES: Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are 2 commonly ordered liver function tests, and ALT has long been considered more liver-specific than AST. Between the 2, the one which is better in predicting liver or non–liver-related mortality remains unsettled.

METHODS: The cohort, 416,122 adults, came from a self-paying comprehensive health surveillance program during 1994–2008 and was followed up till 2008. Mortality came from National Death Index, with 10,412 deaths identified. Hazard ratios (HRs), computed by Cox model, and life expectancy, by life table method, were presented for 5 levels of AST and ALT with elevated AST or ALT defined as ≥40 IU/L. Liver disease included liver cancer and other liver conditions.

RESULTS: There were 3 times more elevated ALT (15.4%) than AST (5.7%). However, those with elevated AST had higher mortality for all-cause (HR = 2.44), for liver disease (HR = 27.2), and for liver cancer (HR = 47.6) than its ALT counterparts (HR = 1.69, 10.8, and 20.2, respectively). Elevated AST also lost more years of life expectancy (10.2) than those lost by ALT (5.2) and larger than most common risks. Elevated AST had increased mortality from all cancers (HR = 3.57), stroke (HR = 1.36), respiratory diseases (HR = 1.34), and injuries (HR = 1.82), other than just liver disease. All-cause mortality remained significantly increased, when high risk groups were excluded, such as frequent drinkers, hepatitis carriers, those died from nonmedical conditions, those died in the first 3 years, or advanced fibrosis index based on 4 factors or aspartate transaminase-to-platelet ratio index. Results were consistent between those returned for second visits and those analyzed in initial visits.

DISCUSSION: Those with elevated AST (≥40 IU/L) had life expectancy cut short by 10.2 years, doubled the number of years lost with elevated ALT. For all-cause and for liver-related mortality, AST was an important predictor, better than ALT.

1Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China;

2Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan;

3Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Lukang Town, Taiwan;

4Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan;

5MJ Health Research Foundation, Taipei, Taiwan;

6Center for Biostatistics, Bioinformatics and Big Data, The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China;

7National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China;

8Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;

9Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, California, USA;

10Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, and Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.

Correspondence: Xifeng Wu, MD, PhD. E-mail: Chi Pang Wen, MD, DrPH. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at

Received October 08, 2018

Accepted June 04, 2019

Online date: August 14, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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