Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis

Abstract

Background: Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention.Methods: A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model.Results: Of eligible 1579 patients with a mean age of 49.3±14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P=0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR)=1.50, 95% confidence index (CI) 1.09-2.07, P=0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR=1.43, 95%CI 1.08-2.41, P=0.002). Conclusions: PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.

The association between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension

“…Variables for adjustment were carefully chosen, given the number of events available, clinical importance, and published studies. [16][17][18] Three models were conducted: model 1, with no adjustment; model 2, with adjusting for age and sex; and model 3, with adjusting for other confounding factors based on model 2. In addition, we also performed smooth curve fitting (penalized spline method) and subgroup analysis.…”

“…For instance, a longitudinal cohort study [16] included 3494 Japanese community-checked subjects that showed a high AST/ALT ratio (>90%) was an independent predictor of all-cause and cardiovascular mortality. Feng et al [17] performed a multicenter retrospective study which consisted of 1579 patients on peritoneal dialysis. It reported that a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR = 1.43, 95% CI:1.08–1.41).…”

“…Meanwhile, AST/ALT ratio variable was transformed into cubic splines to evaluate the association between AST/ALT ratio and all-cause and cardiovascular death. Variables for adjustment were carefully chosen, given the number of events available, clinical importance, and published studies [16–18] . Three models were conducted: model 1, with no adjustment; model 2, with adjusting for age and sex; and model 3, with adjusting for other confounding factors based on model 2.…”