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Combined evaluation of aminotransferases improves risk stratification for overall and cause-specific mortality in older patients

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Abstract

Background

Recent studies identified low levels of alanine aminotransferase (ALT) as strong predictors of mortality in older people.

Aims

Here we verified if the combined evaluation of aminotransferases may improve risk stratification for adverse outcomes in older patients.

Methods

Data are from 761 participants aged more than 65 years from a prospective population-based database (InCHIANTI study), without known baseline chronic liver disease or malignancies. Associations between aminotransferase levels and the risk of all-cause, cardiovascular- and cancer-death were assessed by Cox-models with time-dependent covariates.

Results

The association of ALT and aspartate aminotransferase (AST) with mortality was non-linear, mirroring a J- and a U-shaped curve, respectively. Based on quintiles of transaminase activities and on their association with overall mortality, low, intermediate (reference group) and high levels were defined. Having at least one transaminase in the low range [aHR 1.76 (1.31–2.36), p < 0.001], mainly if both [(aHR 2.39 (1.81–3.15), p < 0.001], increased the risk of overall mortality, as well as having both enzymes in the high range [aHR 2.14 (1.46–3.15), p < 0.001]. While similar trends were confirmed with respect to cardiovascular mortality, subjects with the highest risk of cancer mortality were those with both enzymes in the high range [aHR 3.48 (1.43–8.44), p = 0.006]. Low levels of transaminases were associated with frailty, sarcopenia and disability, while high levels did not capture any known proxy of adverse outcome.

Conclusions and discussion

The prognostic information is maximized by the combination of the 2 liver enzymes. While both aminotransferases in low range are characteristically found in the most fragile phenotype, both enzymes in high range are more likely to identify new-onset vascular/infiltrative diseases with adverse outcome.

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Acknowledgements

The authors are particularly grateful to the InCHIANTI study members who contributed to data collection.

Author information

Authors and Affiliations

  1. Clinical Medicine and Hepatology Unit, Campus Bio-Medico University, Rome, Italy

    Paolo Gallo, Antonio Picardi & Umberto Vespasiani-Gentilucci

  2. Internal Medicine Unit, Campus Bio-Medico University, Via Alvaro del Portillo 200 , Rome, Italy

    Antonio De Vincentis & Raffaele Antonelli Incalzi

  3. Geriatric Unit, Azienda Sanitaria di Firenze Toscana, Firenze, Italy

    Stefania Bandinelli

  4. National Institute on Aging, National Institutes of Health, Baltimore, MD, USA

    Luigi Ferrucci

Authors
  1. Paolo Gallo
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  2. Antonio De Vincentis
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  3. Stefania Bandinelli
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  4. Luigi Ferrucci
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  5. Antonio Picardi
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  6. Raffaele Antonelli Incalzi
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  7. Umberto Vespasiani-Gentilucci
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Corresponding author

Correspondence to Antonio De Vincentis.

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Conflict of interest

Authors have no personal or financial conflicts of interest to declare and the authors did not receive support from any organization for the submitted work.

Sponsor’s role

The InCHIANTI study was supported as a “targeted project” (ICS 110.1/RS97.71) by the Italian Ministry of Health and by the U.S. National Institute on Aging (contracts N01-AG-916413, N01-AG-5-0002, N01-AG-821336, grant R01-AG-027012). The study was also supported in part by the Intramural Research Program of the National Institute on Aging, National Institutes of Health, Baltimore, Maryland.

Ethical approval

The study protocol was approved by the Italian National Research Council on Aging (INRCA, Florence, Italy) Ethical Committee.

Informed consent

Informed consent to participate in the study was obtained from participants.

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Gallo, P., De Vincentis, A., Bandinelli, S. et al. Combined evaluation of aminotransferases improves risk stratification for overall and cause-specific mortality in older patients. Aging Clin Exp Res 33, 3321–3331 (2021). https://doi.org/10.1007/s40520-021-01979-9

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