Baseline low ALT activity is associated with increased long-term mortality after COPD exacerbations

Abstract

Background: COPD exacerbations have negative impact on patients' survival. Several risk factors for grave outcomes of such exacerbations have been descried. Muscle dysfunction and mass loss were shown to impact negatively on prognosis and survival. Low activity of the enzyme ALT (Alanine amino-transferase) in the blood is a known indicator for sarcopenia and frailty, however, no previous studies addressed the association of low ALT amongst patients hospitalized due to COPD exacerbation and long-term survival. Methods: This is a historic prospective cohort study of patients hospitalized due to acute COPD exacerbation. Results: Included were 232 consecutive COPD exacerbation patients. The median time of follow-up was 34.9 months (IQR 23.13-41.73 months). During this period 104 (44.8%) patients died. All patients were grouped to quartiles according to blood ALT levels (after exclusion of cases considered to have hepatic tissue damage (ALT > 40 IU)). The risk of long-term mortality increased, in a statistically significant manner, amongst patients with low ALT values: the median survival of patients with ALT < 11 IU was 18.5 months only while the median survival for the rest of the study group was not reached. For ALT < 11 IU; 12-16 IU; 17-20 IU and > 21 IU the mortality rates were 69%; 40.9%; 36.3 and 25% respectively (p < 0.001 for comparison of lower quartile with upper three quartiles). The crude hazard ratio for mortality amongst patients with ALT levels lower than 11 IU was 2.37 (95% CI; 1.6-3.5). This increased risk of mortality remained significant after adjustment for age, weight, creatinine, albumin concentration and cardiovascular diseases (HR = 1.83; 95% CI 1.08-3.1, p < 0.05). Conclusions: Low ALT values, a biomarker of sarcopenia and frailty, are associated with poor long-term survival amongst patients hospitalized due to COPD exacerbation.

Low ALT Levels Associated with Poor Outcomes in 8700 Hospitalized Heart Failure Patients

“…Serum ALT is a readily available, inexpensive, and routine biochemical assay used in clinical practice. A large number of studies have established the association between low ALT levels and sarcopenia and frailty in both middle-aged [ 22 ] and elderly patients [ 16 , 37 ] and in a myriad of clinical contexts [ 18 , 19 ]. A prospective study of 179 patients in an internal ward found that low ALT blood activity and high Frail questionnaire score correlated with increased mortality and with each other [ 17 ].…”

“…Nevertheless, when the liver parenchyma is intact, ALT blood levels (demonstrated as catalytic activity) are a good marker for the whole-body skeletal muscle mass [ 14 , 15 ]. Utilizing the aforementioned, a large body of evidence accumulated in the past years, marking lower ALT values as a reliable marker for sarcopenia and frailty, in large, heterogeneous patient populations [ 16 , 17 , 18 , 19 ]. Characterizing sarcopenia and frailty status in patients with HF may provide clinicians with an indicator for gauging disease severity, prognosis, and disease progression or reversal.…”

Association of low alanine aminotransferase values with extubation failure in adult critically ill patients: A retrospective cohort study

“…(13,16) It was recently shown that low ALT levels are associated with reduced muscle strength, adverse outcomes in the general population of hospitalized patients, patients with chronic obstructive pulmonary disease exacerbation, and rehabilitation program participants. (12,15,16,32) To the best of our knowledge, this is the rst study to assess the correlation between low ALT and extubation failure.…”

“…A low ALT level in the peripheral blood is associated with low muscle mass. (12) Previous studies have demonstrated a correlation between ALT values and muscle mass, as assessed by CT measurements. (13) Recent studies in different clinical elds have shown that low ALT is a reliable biomarker for sarcopenia.…”

“…(13) Recent studies in different clinical elds have shown that low ALT is a reliable biomarker for sarcopenia. (12,(14)(15)(16) We hypothesized that low ALT blood levels, a known biomarker for sarcopenia, might also be associated with an increased risk of extubation failure in critically ill medical mechanically ventilated patients.…”