Background Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are commonly ordered tests in general medical practice. However, their distribution and significance in older adults are understudied. As such, we aimed to evaluate sex-stratified distribution of both ALT and AST in older adults (≥70 years) and assess for associations with mortality. Methods Post-hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized, placebo-controlled trial of daily low-dose aspirin for initially relatively healthy older persons. Univariate analysis and multiple logistic regression were used to explore baseline characteristics. Cox regression and restricted cubic splines were used to examine links between transaminase levels and mortality. Results Of the 11 853 participants with ALT and AST levels, 1 054 (8.9%) deaths were recorded over a median of 6.4 (interquartile range [IQR] 5.4–7.6) years. For ALT, the lowest quintiles for males and females were 6–15 and 5–13 U/L, respectively; for AST, the lowest quintiles were 8–18 and 7–17 U/L, respectively. On both univariate and models adjusted for covariates including age, body mass index, frailty, diabetes, and kidney disease, males and females in the lowest quintile of ALT had an increased hazard of mortality (aHR 1.51 [95% confidence interval {CI} 1.14–1.99] and aHR 1.39 [95% CI 1.03–1.88], respectively). For the lowest quintile of AST, only males were at increased risk (aHR 1.33 [95% CI 1.04–1.70]). Associations remained significant when removing outliers. Conclusions Low ALT levels independently confer an increased hazard of mortality for older males and females; low AST only affected older male survival. Further evaluation of mechanisms would be worthwhile, and re-evaluating the lower limit of normal for ALT in older adults should be considered.

中文翻译：

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血清转氨酶和老年人的分布及其与全因死亡率的相关性


背景 丙氨酸氨基转移酶 （ALT） 和天冬氨酸氨基转移酶 （AST） 是一般医疗实践中常用的检查。然而，它们在老年人中的分布和意义研究不足。因此，我们旨在评估老年人 （≥70 岁） 中 ALT 和 AST 的性别分层分布，并评估与死亡率的相关性。方法 ASPirin 在减少老年人事件 （ASPREE） 随机、安慰剂对照试验中对最初相对健康的老年人每日低剂量阿司匹林的事后分析。采用单因素分析和多元 logistic 回归探讨基线特征。使用 Cox 回归和限制性三次样条来检查转氨酶水平与死亡率之间的联系。结果 在 11 853 名具有 ALT 和 AST 水平的参与者中，记录了 1 054 例 （8.9%） 死亡，中位数为 6.4 （四分位距 [IQR] 5.4-7.6） 年。对于 ALT，男性和女性的最低五分位数分别为 6-15 和 5-13 U/L;对于 AST，最低的五分位数分别为 8-18 和 7-17 U/L。在单变量和协变量（包括年龄、体重指数、虚弱、糖尿病和肾病）调整的模型中，ALT 最低五分位数的男性和女性死亡风险增加（aHR 1.51 [95% 置信区间 {CI} 1.14-1.99] 和 aHR 1.39 [95% CI 1.03-1.88] 分别为）。对于 AST 的最低五分位数，只有男性风险增加 （aHR 1.33 [95% CI 1.04–1.70]）。删除异常值时，关联仍然很重要。结论 低 ALT 水平独立增加老年男性和女性的死亡风险;低 AST 仅影响老年男性的生存率。 进一步评估机制是值得的，应考虑重新评估老年人 ALT 的正常下限。