Low alanine aminotransferase activity in older people is associated with greater long-term mortality

OBJECTIVES: To find possible association between liver enzymes and mortality in older people. DESIGN: A prospective cohort study. SETTING: Jerusalem. PARTICIPANTS: A systematically selected representative sample of 455 70-year-old ambulatory individuals was prospectively followed for 12 years. MEASUREMENTS: An extensive social and medical profile was developed at age 70 using a detailed interview and physical and ancillary examination. Information on mortality was obtained annually. Differences in survival between subjects stratified according to liver enzyme levels were assessed using the Kaplan-Meier method. Multivariable survival analyses using a Cox proportional hazards model were performed to determine the association between liver enzyme levels at age 70 and mortality over 12 years. RESULTS: Median alanine aminotransferase (ALT) activity of the study population was 11.00 U/L for women and 13.00 U/L for men. Twelve-year survival rates for women with ALT below and above the median levels were similar (78%). For men, these rates were 54% and 65%, respectively (P<.001). Proportional hazards models demonstrated that this greater mortality risk was independent of numerous common risk factors for mortality (hazard ratio (HR)=1.5, 95% confidence interval (CI)=1.08-2.19). Adding an interaction between sex and low ALT to the model demonstrated a higher risk of mortality for men with low ALT levels (HR=2.42, 95% CI=1.15-5.08). No such risk was demonstrated for the other liver enzymes. CONCLUSION: ALT activity represents a strong and independent surrogate marker for mortality in community-dwelling elderly men.