Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure

Maeda, Daichi; Kagiyama, Nobuyuki; Jujo, Kentaro; Saito, Kazuya; Kamiya, Kentaro; Saitô, Hiroshi; Maekawa, Emi; Konishi, Masaaki; Kitai, Takeshi; Iwata, K.; Wada, Hiroshi; Hiki, Masaru; Dotare, Taishi; Sunayama, Tsutomu; Kasai, Takatoshi; Nagamatsu, Hirofumi; Ozawa, Tetsuya; Izawa, Katsuya; Yamamoto, Shuhei; Aizawa, Naoki; Yonezawa, Ryusuke; Oka, Kazuhiro; Momomura, Shin‐ichi; Matsue, Yuya

doi:10.1038/s41598-021-91368-z

Cited by 23 publications

(27 citation statements)

References 34 publications

(30 reference statements)

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“…Besides high serum AST with normal ALT could reflect widespread skeletal muscle pathology (37). Thus, AST to ALT ratio may be a good indicator for frailty and sarcopenia in older patients (38) and multivariate logistic regression model also showed that fasting insulin (OR=0.919, [95%CI: 0.878-0.922] P=0.000) and AST to ALT ratio (OR=2.771, [95%CI: 1.544-2.342] P=0.000) were risk factors for sarcopenia. Although TP, ALB and PA can all reflect the nutritional status of the body, ALB and PA are more recommended in the evaluation of the nutritional status of patients with sarcopenia, and their corresponding AUC is 0.604 and 0.609, respectively.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Clinical Laboratory Indicators With Sarcopenia: Results From the West China Health and Aging Trend Study

et al. 2021

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BackgroundSarcopenia is an age-related and skeletal muscle disorder involving the loss of muscle mass or strength, and physiological function. Although the diagnostic indicators used in the different guidelines are for muscle mass, strength and physical performance, there are currently no uniform diagnostic criteria. Therefore, we aimed to explore the relationship between a series of biomarkers with sarcopenia in southwest China.MethodsWe included 4302 patients from West China Health and Aging Trend (WCHAT) study. Sarcopenia was defined according to the Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. Thyroxine、albumin、total protein、prealbumin、albumin to globulin ratio (A/G)、25(OH)VD、fasting insulin、adrenal cortisol、triglyceride、high-density lipoprotein、hemoglobin and aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) were measured. The receiver operating characteristic curves (ROC) were established to describe the predictive value for sarcopenia and we also used multivariate logistic regression analysis to identify risk factors of the disease.ResultsIn terms of protein state, patients with sarcopenia had lower value in total protein, albumin, prealbumin, A/G than the control (P<0.001). Patients had lower value in triglyceride but higher value in high-density lipoprotein compared with the healthy in the indicators of lipid metabolism (P<0.001). In the aspect of hormone state, patients had lower free triiodothyronine, fasting insulin but higher free tetraiodothyronine and adrenal cortisol than the healthy (P<0.001). The fasting insulin level (AUC=0.686) and the AST/ALT ratio (AUC=0.682) were the best predictors of sarcopenia among biomarkers. The diagnostic performance of fasting insulin combined with the AST/ALT ratio (AUC=0.720) is equal to multiple indicators (AUC=0.742).ConclusionThe fasting insulin combined with the AST/ALT ratio exhibits good diagnostic performance for sarcopenia.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Clinical Laboratory Indicators With Sarcopenia: Results From the West China Health and Aging Trend Study

et al. 2021

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“…Systemic venous congestion and hypoperfusion due to heart failure lead to liver dysfunction and abnormal liver function tests, with a subsequent increase in liver fibrosis markers. 2 So far, numerous liver fibrosis markers have been reported to be associated with poor prognosis in patients with heart failure [3][4][5] ; however, the optimal liver fibrosis marker for heart failure has not been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of the liver fibrosis marker fibrosis‐5 index in patients with acute heart failure

et al. 2022

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Aims Recently, liver fibrosis markers, such as the fibrosis-4 index (FIB-4), have been shown to be associated with prognosis in patients with heart failure. The fibrosis-5 (FIB-5) index, which assesses albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, is a simple liver fibrosis marker that was reported to be superior to FIB-4 for differentiation of liver fibrosis. This study aimed to compare the prognostic value of FIB-4 and FIB-5 in patients with heart failure. Methods and resultsThe FIB-4 and FIB-5 scores were calculated at discharge in 906 patients hospitalized with heart failure. The patients were stratified into three groups based on their FIB-5 scores: low (n = 303), middle (n = 301), and high (n = 302) FIB-5 groups. The primary endpoint was a composite of cardiac death or rehospitalization for heart failure. The low FIB-5 group was older and had larger inferior vena cava diameters and higher brain natriuretic peptide levels than the other two groups. The primary endpoint occurred in 156 (51.5%), 110 (36.5%), and 54 patients (17.9%) in the low, middle, and high FIB-5 groups, respectively (P < 0.001). On Cox proportional hazard analysis, the low FIB-5 was independently associated with the primary endpoint after adjustment for confounding factors. The association was consistent in both patients with preserved and reduced left ventricular ejection fraction (LVEF), and there was no significant interaction between LVEF phenotypes in terms of the prognostic impact of FIB-5 (P for interaction = 0.311). FIB-5 was superior to FIB-4 as a prognostic indicator of the primary endpoint (continuous net reclassification improvement, 0.530; 95% confidence interval [CI], 0.399-0.662; P < 0.001; integrated discrimination improvement, 0.072; 95% CI, 0.057-0.088; P < 0.001). Conclusions The FIB-5 is a useful risk stratification marker with better prognostic value than FIB-4 in patients hospitalized with heart failure.

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“…Maeda and his colleagues also revealed that AST/ALT is more strongly correlated with the 1-year mortality, independent of other covariates, other than ALT alone. This is likely because the AST and ALT proportion may offset the influence from liver dysfunction, thereby making AST/ALT more specific to muscle capacity [ 16 ]. ALT is a key enzyme in gluconeogenesis, whereby muscle protein is broken down to amino acids, which, in turn, converts alanine to alpha-ketoglutarate for glucose and/or energy production.…”

Section: Discussionmentioning

confidence: 99%

Clinical muscle mass-related biomarkers that predict mortality in older patients with community-acquired pneumonia

et al. 2022

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Objective Community-acquired pneumonia (CAP) is associated with elevated morbidity and mortality, and it usually occurs in older adults. Our goal here was to assess the efficacies of muscle mass-related biomarkers, such as, aspartate transaminase/alanine transaminase (AST/ALT) and creatinine/cystatin C*100 (Cr/CysC*100), in predicting 1-, 2-, and 3-year mortalities of older CAP patients. Methods Design: Retrospective cohort study. Setting and Participants: A teaching hospital in western China. Hospitalized CAP patients, aged≥60 years. We separated patients into a high or low muscle mass group, according to the median AST/ALT and Cr/CysC*100, respectively. We acquired data from medical records and local government mortality databases, as well as telephonic interviews. We analyzed the association between low muscle mass (AST/ALT and Cr/CysC*100) and all-cause mortality at 1, 2, and 3 years in older patients with CAP. Results We enrolled 606 patients (58.58% male; median age: 81 years) for analysis. The 1-, 2-, and 3-year mortality in older patients with CAP in the low muscle mass group (AST/ALT) was higher than in the high muscle mass group (AST/ALT) (1-year: 51.16% vs. 36.96%, p < 0.001; 2-year: 54.46% vs. 41.25%, p = 0.001; 3-year: 54.79% vs. 42.9%, p = 0.003). Upon adjustment of potential confounding factors, we revealed, using cox regression analysis, that the low muscle mass group (AST/ALT) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow-ups, compared to the high muscle mass group (AST/ALT) (1-year: hazard ratios (HR) = 1.46, 95% confidence interval (CI): 1.13–1.88; 2-year: HR = 1.39, 95% CI: 1.09–1.77; 3-year: HR = 1.35, 95% CI: 1.06–1.72). The 1-, 2-, and 3-year mortality of older CAP patients in the low muscle mass group (Cr/CysC*100) was also higher than the high muscle mass group (Cr/CysC*100) (1-year: 56.29% vs. 31.91%, p < 0.001; 2-year: 60.26% vs. 35.53%, p < 0.001; 3-year: 61.26% vs. 36.51%, p < 0.001). Compared to the high muscle mass group (Cr/CysC*100), the low muscle mass group (Cr/CysC*100) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow ups (1-year: HR = 1.9, 95% CI: 1.46–2.48; 2-year: HR = 1.85, 95% CI: 1.44–2.39; 3-year: HR = 1.85, 95% CI: 1.44–2.37). Conclusions Low muscle mass (AST/ALT and Cr/CysC*100) were associated with enhanced 1-, 2-, and 3-year mortality risk in older patients with CAP.

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Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure

Cited by 23 publications

References 34 publications

Diagnostic Performance of Clinical Laboratory Indicators With Sarcopenia: Results From the West China Health and Aging Trend Study

Diagnostic Performance of Clinical Laboratory Indicators With Sarcopenia: Results From the West China Health and Aging Trend Study

Prognostic value of the liver fibrosis marker fibrosis‐5 index in patients with acute heart failure

Clinical muscle mass-related biomarkers that predict mortality in older patients with community-acquired pneumonia

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