Browse > Article
http://dx.doi.org/10.3340/jkns.2020.0212

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)
Publication Information
Journal of Korean Neurosurgical Society / v.64, no.3, 2021 , pp. 460-468 More about this Journal
Abstract
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.
Keywords
Alanine transaminase; Frail elderly; Frailty; Intracranial hemorrhages; Mortality;
Citations & Related Records
연도 인용수 순위
  • Reference
1 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
2 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
3 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   DOI
4 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   DOI
5 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   DOI
6 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   DOI
7 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   DOI
8 Pratt DS, Kaplan MM : Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 342 : 1266-1271, 2000   DOI
9 Schmucker DL : Age-related changes in liver structure and function: implications for disease ? Exp Gerontol 40 : 650-659, 2005   DOI
10 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   DOI
11 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   DOI
12 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
13 Dziedzic T : Systemic inflammation as a therapeutic target in acute ischemic stroke. Expert Rev Neurother 15 : 523-531, 2015   DOI
14 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   DOI
15 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
16 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   DOI
17 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   DOI
18 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   DOI
19 Alter G, Riley JC : Frailty, sickness, and death: models of morbidity and mortality in historical populations. Popul Stud (Camb) 43 : 25-45, 1989   DOI
20 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   DOI
21 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   DOI
22 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.   DOI
23 Bortz WM 2nd : A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 57 : M283-M288, 2002   DOI
24 Cameron ID, Kurrle SE : Frailty and rehabilitation. Interdiscip Top Gerontol Geriatr 41 : 137-150, 2015   DOI
25 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   DOI
26 Whiteley W, Chong WL, Sengupta A, Sandercock P : Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke 40 : e380-e389, 2009
27 Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, et al. : Global stroke statistics. Int J Stroke 12 : 13-32, 2017   DOI
28 Towfighi A, Ovbiagele B : The impact of body mass index on mortality after stroke. Stroke 40 : 2704-2708, 2009   DOI
29 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   DOI