%0 Journal Article
%T Associations of serum liver enzyme levels and their changes over time with all-cause and cause-specific mortality in the general population: a large-scale national health screening cohort study
%A Chee Hae Kim
%A Haebin Kim
%A Ho Kyung Sung
%A Jungmin Joo
%A Kyoung-Nam Kim
%A Yong Jin Kwon
%J -
%D 2019
%R 10.1136/bmjopen-2018-026965
%X Objectives To investigate the associations of the levels of liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT), at baseline and their changes over time with mortality.

Design Cohort study.

Setting, participants and outcome measures We analysed the data of 484ˋ472 individuals from the National Health Insurance Service-National Health Screening Cohort (2002每2013). We used two exposure indices: (1) deciles of baseline ALT, AST and GGT levels measured in 2002 or 2003 and (2) deciles of changes in ALT, AST and GGT levels over a 4ˋyear period (2002每2006 or 2003每2007). We constructed Cox models to evaluate the associations of these exposure indices with mortality (2008每2013).

Results We found non-monotonic dose每response associations between the baseline levels of ALT and AST and all-cause mortality. We also found a monotonic non-linear association between the baseline levels of GGT and all-cause mortality (10th decile: HR=2.05, 95% CI: 1.93 to 2.18). Compared with the ninth, sixth and fourth deciles of changes in ALT (8每13ˋU/L), AST (1ˋU/L) and GGT (ˋ3 to ˋ2ˋU/L) over time, respectively, the risks of all-cause mortality increased in both the higher and lower deciles of changes in the corresponding liver enzyme levels (10th decile: HR=1.36, 95%ˋCI 1.24 to 1.48; 1st decile: HR=1.46, 95%ˋCI 1.34 to 1.59 for ALT; 10th decile: 1.55, 95%ˋCI 1.40 to 1.71; 1st decile: HR=1.53, 95%ˋCI 1.38 to 1.69 for AST; 10th decile: HR=1.71, 95%ˋCI 1.56 to 1.88; 1st decile: HR=1.67, 95%ˋCI 1.52 to 1.84 for GGT). These non-monotonic dose每response associations remained when analyses were stratified by the medians or quartiles of the baseline liver enzyme levels.

Conclusions The levels of liver enzymes at baseline and over time showed non-linear associations with mortality
%U https://bmjopen.bmj.com/content/9/5/e026965