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Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38050.593634.63 (Published 22 April 2004) Cite this as: BMJ 2004;328:983
  1. Chang Kim Hyeon, instructor1,
  2. Mo Nam Chung, associate professor1,
  3. Ha Jee Sun, assistant professor2,
  4. Hyub Han Kwang, professor3,
  5. Dae Kyu Oh, director4,
  6. Il Suh (isuh{at}yumc.yonsei.ac.kr), professor1
  1. 1Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, Seoul 120-752, Republic of Korea
  2. 2 Graduate School of Health Science and Management, Yonsei University, Seoul
  3. 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul
  4. 4Bureau of Health Promotion, Ministry of Health and Welfare, Republic of Korea
  1. Correspondence to: I Suh
  • Accepted 28 January 2004

Abstract

Objective To examine the relation between the normal range of serum aminotransferase concentration and mortality from liver disease.

Design Prospective cohort study.

Setting Korea Medical Insurance Corporation study with eight years' follow up.

Participants 94 533 men and 47 522 women aged 35-59 years.

Main outcome measure Mortality from liver diseases according to death certificate.

Results There was a positive association between the aminotransferase concentration, even within normal range (35-40 IU/l), and mortality from liver disease. Compared with the concentration < 20 IU/l, the adjusted relative risks for an aspartate aminotransferase concentration of 20-29 IU/l and 30-39 IU/l were 2.5 (95% confidence interval 2.0 to 3.0) and 8.0 (6.6 to 9.8) in men and 3.3 (1.7 to 6.4) and 18.2 (8.1 to 40.4) in women, respectively, The corresponding risks for alanine aminotransferase were 2.9 (2.4 to 3.5) and 9.5 (7.9 to 11.5) in men and 3.8 (1.9 to 7.7) and 6.6 (1.5 to 25.6) in women, respectively. According to receiver operating characteristic curves the best cut-off values for the prediction of liver disease in men were 31 IU/l for aspartate aminotransferase and 30 IU/l for alanine aminotransferase.

Conclusion People with slightly increased aminotransferase activity, but still within the normal range, should be closely observed and further investigated for liver diseases.

Footnotes

  • Contributors HCK contributed to study concept and design, analysis and interpretation of the data, and preparation of the manuscript. CMN and SHJ contributed to study design, data analysis and interpretation, and editing the manuscript. KHH and DKOcontributed to data analysis and interpretation and editing of the manuscript. IS contributed to study concept and design, analysis and interpretation of data, preparation of the manuscript, and supervision of the study and is guarantor.

  • Funding Supported, in part, by a grant from the 21C Frontier Functional Human Genome Project of the Ministry of Science and Technology of Korea.

  • Competing interests None declared.

  • Ethical approval Institutional review board of Severance Hospital at Yonsei University.

  • Accepted 28 January 2004
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