SynthesisPloS one2014
Complex association between alanine aminotransferase activity and mortality in general population: a systematic review and meta-analysis of prospective studies.
Synthesis in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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The trial behind it
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Who cites it
27 citing papers in PubMed, 52 citations in OpenAlex.
- Trial
- Long-term integrative personalized medicine care in massive brainstem hemorrhage: A CARE-compliant case report.Medicine · 2026Article
- Liver, ageing and disease.Nature reviews. Gastroenterology & hepatology · 2025Review
- An Update on the Role of Alanine Aminotransferase in the Detection of Chronic Liver Diseases Relevant to Primary Care.Oman medical journal · 2025Review
- Article
- Lower alanine aminotransferase levels are associated with increased all-cause and cardiovascular mortality in nonalcoholic fatty liver patients.World journal of hepatology · 2023Article
- Article
- Extremely Low Activity of Serum Alanine Aminotransferase Is Associated with Long-Term Overall-Cause Mortality in the Elderly Patients Undergoing Percutaneous Coronary Intervention after Acute Coronary Syndrome.Medicina (Kaunas, Lithuania) · 2023Article
- Elevated AST/ALT ratio is associated with all-cause mortality in patients with stable coronary artery disease: a secondary analysis based on a retrospective cohort study.Scientific reports · 2022Article
- Association between alanine aminotransferase and all-cause mortality rate: Findings from a study on Japanese community-dwelling individuals.Journal of clinical laboratory analysis · 2022Article
- High Aspartate Aminotransferase/Alanine Aminotransferase Ratio May Be Associated with All-Cause Mortality in the Elderly: A Retrospective Cohort Study Using Artificial Intelligence and Conventional Analysis.Healthcare (Basel, Switzerland) · 2022Article
- Relationship between liver function tests & cardiovascular risk factors in stage 3-5 pre-dialysis chronic kidney disease.The Indian journal of medical research · 2022Article
- The association between serum liver enzymes and cancer mortality.Clinical and experimental medicine · 2022Article
- Development and Validation of a New Multiparametric Random Survival Forest Predictive Model for Breast Cancer Recurrence with a Potential Benefit to Individual Outcomes.Cancer management and research · 2022Article
- Significantly Reduced Alanine Aminotransferase Level Increases All-Cause Mortality Rate in the Elderly after Ischemic Stroke.International journal of environmental research and public health · 2021Article
- Extremely Low Serum Alanine Transaminase Level Is Associated with All-Cause Mortality in the Elderly after Intracranial Hemorrhage.Journal of Korean Neurosurgical Society · 2021Article
- Serum alanine aminotransferase activity and risk factors for cardiovascular disease in a Caucasian population: the Tromsø study.BMC cardiovascular disorders · 2021Article
- Circulating liver enzymes and risks of chronic diseases and mortality in the prospective EPIC-Heidelberg case-cohort study.BMJ open · 2020Article
- Article
- Observational
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveControversy exists in using alanine aminotransferase (ALT) activity for predicting long-term survival. Therefore, this research study investigated the association between ALT activity and mortality through a systematic review and meta-analysis of previous prospective studies.
methodsElectronic literature databases, including PubMed, Embase, and the Institute for Scientific Information (ISI), were searched for relevant prospective observational studies (published before Dec 30, 2013) on the association between baseline ALT activity and ensuing all-cause/disease-specific mortality. Information on nationality, sample size, participant characteristics, follow-up duration, comparison, outcome assessment, hazard ratios (HRs) and adjusted covariates was extracted. Pooled HRs and corresponding 95% confidence intervals (CIs) were separately calculated for categorical risk estimates (highest vs. lowest ALT categories) and continuous risk estimates (per 5 U/l of ALT increment) in subgroups separated by age (<70/≥ 70 years).
resultsA total of twelve prospective cohort studies, totaling 206,678 participants and 16,249 deaths, were identified and analyzed. In the younger age group, the pooled HR for mortality related to liver-disease was about 1.24 (95% CI: 1.23-1.25) per 5 U/l of ALT increment. The dose-response HRs of all-cause mortality, cardiovascular (CV) disease-related mortality, and cancer-related mortality were 0.91 (0.88-0.94), 0.91 (0.85-0.96), 0.92 (0.86-0.98) respectively per 5 U/l of ALT elevation, with insignificant heterogeneity in the older population. There was an approximate decrease of 4‰ observed on HRs of all-cause, CV-related, and cancer-related mortality followed with one year's increment through meta-regression (all P<0.05).
conclusionsThe ALT-mortality association was inconsistent and seems particularly susceptible to age after synthesizing the previous prospective studies. In terms of the age, ALT activity was more valuable in predicting mortality in the older population; extremely low ALT levels indicated a higher all-cause, CV-related, and cancer-related mortality. ALT activity may therefore be a useful biomarker when predicting the long-term survival of elderly patients.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.