Journal of Korean Neurosurgical Society

  • 제64권3호
  • /
  • Pages.460-468
  • /
  • 2021
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Extremely Low Serum Alanine Transaminase Level Is Associated with All-Cause Mortality in the Elderly after Intracranial Hemorrhage

  • Kim, Doo Young (Department of Rehabilitation Medicine, Catholic Kwandong University International St. Mary's Hospital) ;
  • Cho, Kwang-Chun (Department of Neurosurgery, Catholic Kwandong University International St. Mary's Hospital)
  • 투고 : 2020.07.21
  • 심사 : 2020.09.29
  • 발행 : 2021.05.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Extremely low alanine transaminase (ALT) levels are associated with all-cause mortality in frail elderly individuals; the clinical significance of ALT as a reliable biomarker is now being considered. Predicting mortality with routine tests at the time of diagnosis is important for managing patients after intracranial hemorrhage. We aimed to investigate whether an extremely low ALT level is associated with mortality in the elderly after intracranial hemorrhage. Methods : A retrospective review was performed on 455 patients with intracranial hemorrhage admitted to a university-affiliated tertiary care hospital from February 2014 to May 2019. Multivariate Cox regression analysis was performed for all ages and for each age group to determine whether an extremely low ALT level is an independent predictor of mortality only in the elderly. Results : Overall, 294 patients were enrolled, and the mean age of the subjects was 59.1 years, with 99 (33.8%) aged ≥65 years. The variables associated with all-cause mortality in all subjects were age, C-reactive protein (CRP) levels, hemoglobin (Hb) levels (<11 g/dL), and initial Glasgow coma scale (GCS) scores. In young patients, CRP, low Hb levels, and initial GCS scores were significantly associated with all-cause mortality. However, in the elderly (≥65 years), the variables significantly associated with all-cause mortality were extremely low levels of ALT (<10 U/L) (adjusted hazard ratio, 3.313; 95% confidence interval, 1.232-8.909; p=0.018) and initial GCS scores. Conclusion : Extremely low ALT level (<10 U/L) at the time of diagnosis is a significant risk factor for all-cause mortality in the elderly after intracranial hemorrhage.

키워드

참고문헌

  1. Alter G, Riley JC : Frailty, sickness, and death: models of morbidity and mortality in historical populations. Popul Stud (Camb) 43 : 25-45, 1989 https://doi.org/10.1080/0032472031000143836
  2. Ayis SA, Coker B, Rudd AG, Dennis MS, Wolfe CD : Predicting independent survival after stroke: a European study for the development and validation of standardised stroke scales and prediction models of outcome. J Neurol Neurosurg Psychiatry 84 : 288-296, 2013 https://doi.org/10.1136/jnnp-2012-303657
  3. Baztan JJ, Galvez CP, Socorro A : Recovery of functional impairment after acute illness and mortality: one-year follow-up study. Gerontology 55 : 269-274, 2009. https://doi.org/10.1159/000193068
  4. Bortz WM 2nd : A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 57 : M283-M288, 2002 https://doi.org/10.1093/gerona/57.5.M283
  5. Cameron ID, Kurrle SE : Frailty and rehabilitation. Interdiscip Top Gerontol Geriatr 41 : 137-150, 2015 https://doi.org/10.1159/000381229
  6. Chang PE, Goh BG, Ekstrom V, Ong ML, Tan CK : Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis. World J Hepatol 9 : 959-966, 2017 https://doi.org/10.4254/wjh.v9.i22.959
  7. Corti MC, Guralnik JM, Salive ME, Sorkin JD : Serum albumin level and physical disability as predictors of mortality in older persons. JAMA 272 : 1036-1042, 1994 https://doi.org/10.1001/jama.1994.03520130074036
  8. Dagan A, Sella T, Urban D, Onn A, Bar J, Segal G : Low alanine transaminase is not associated with increased rate of mortality in patients with advanced lung cancer. JCSM Clinical Reports 2 : 1-5, 2017
  9. de Souza SP, Matos RS, Barros LL, Rocha PN : Inverse association between serum creatinine and mortality in acute kidney injury. J Bras Nefrol 36 : 469-475, 2014
  10. Dziedzic T : Systemic inflammation as a therapeutic target in acute ischemic stroke. Expert Rev Neurother 15 : 523-531, 2015 https://doi.org/10.1586/14737175.2015.1035712
  11. Elinav E, Ackerman Z, Maaravi Y, Ben-Dov IZ, Ein-Mor E, Stessman J : Low alanine aminotransferase activity in older people is associated with greater long-term mortality. J Am Geriatr Soc 54 : 1719-1724, 2006 https://doi.org/10.1111/j.1532-5415.2006.00921.x
  12. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G : Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59 : M255-M263, 2004 https://doi.org/10.1093/gerona/59.3.M255
  13. Fried LP, Tangen CM, Waltson J, Newman AB, Hirsch C, Gottdiener J, et al. : Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56 : 146-155, 2001
  14. Gilbertson DT, Ebben JP, Foley RN, Weinhandl ED, Bradbury BD, Collins AJ : Hemoglobin level variability: associations with mortality. Clin J Am Soc Nephrol 3 : 133-138, 2008 https://doi.org/10.2215/CJN.01610407
  15. Kim WR, Flamm SL, Di Bisceglie AM, Bodenheimer HC; Public Policy Committee of the American Association for the Study of Liver Disease : Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease. Hepatology 47 : 1363-1370, 2008 https://doi.org/10.1002/hep.22109
  16. Le Couteur DG, Blyth FM, Creasey HM, Handelsman DJ, Naganathan V, Sambrook PN, et al. : The association of alanine transaminase with aging, frailty, and mortality. J Gerontol A Biol Sci Med Sci 65 : 712-717, 2010
  17. Lee TH, Kim WR, Benson JT, Therneau TM, Melton LJ 3rd : Serum aminotransferase activity and mortality risk in a United States community. Hepatology 47 : 880-887, 2008 https://doi.org/10.1002/hep.22090
  18. Lee Y, Kim J, Han ES, Ryu M, Cho Y, Chae S : Frailty and body mass index as predictors of 3-year mortality in older adults living in the community. Gerontology 60 : 475-482, 2014 https://doi.org/10.1159/000362330
  19. Liu Z, Ning H, Que S, Wang L, Qin X, Peng T : Complex association between alanine aminotransferase activity and mortality in general population: a systematic review and meta-analysis of prospective studies. PLoS One 9 : e91410, 2014 https://doi.org/10.1371/journal.pone.0091410
  20. Luengo-Fernandez R, Paul NL, Gray AM, Pendlebury ST, Bull LM, Welch SJ, et al. : Population-based study of disability and institutionalization after transient ischemic attack and stroke: 10-year results of the Oxford Vascular Study. Stroke 44 : 2854-2861, 2013 https://doi.org/10.1161/STROKEAHA.113.001584
  21. Okamura T, Hayakawa T, Hozawa A, Kadowaki T, Murakami Y, Kita Y, et al. : Lower levels of serum albumin and total cholesterol associated with decline in activities of daily living and excess mortality in a 12-year cohort study of elderly Japanese. J Am Geriatr Soc 56 : 529-535, 2008 https://doi.org/10.1111/j.1532-5415.2007.01549.x
  22. Pratt DS, Kaplan MM : Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 342 : 1266-1271, 2000 https://doi.org/10.1056/NEJM200004273421707
  23. Schmucker DL : Age-related changes in liver structure and function: implications for disease ? Exp Gerontol 40 : 650-659, 2005 https://doi.org/10.1016/j.exger.2005.06.009
  24. Soud M, Alahdab F, Ho G, Kuku KO, Cejudo-Tejeda M, Hideo-Kajita A, et al. : Usefulness of skeletal muscle area detected by computed tomography to predict mortality in patients undergoing transcatheter aortic valve replacement: a meta-analysis study. Int J Cardiovasc Imaging 35 : 1141-1147, 2019 https://doi.org/10.1007/s10554-019-01582-0
  25. Stahon KE, Bastian C, Griffith S, Kidd GJ, Brunet S, Baltan S : Age-related changes in axonal and mitochondrial ultrastructure and function in white matter. J Neurosci 36 : 9990-10001, 2016 https://doi.org/10.1523/JNEUROSCI.1316-16.2016
  26. Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, et al. : Global stroke statistics. Int J Stroke 12 : 13-32, 2017 https://doi.org/10.1177/1747493016676285
  27. Towfighi A, Ovbiagele B : The impact of body mass index on mortality after stroke. Stroke 40 : 2704-2708, 2009 https://doi.org/10.1161/strokeaha.109.550228
  28. Tsivgoulis G, Katsanos AH, Patousi A, Pikilidou M, Birbilis T, Mantatzis M, et al. : Stroke recurrence and mortality in northeastern Greece: the Evros Stroke Registry. J Neurol 265 : 2379-2387, 2018 https://doi.org/10.1007/s00415-018-9005-6
  29. Whiteley W, Chong WL, Sengupta A, Sandercock P : Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke 40 : e380-e389, 2009