Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction.
Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction.
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DOI：
10.1186/s12872-021-01903-z
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发表时间：
2021-02-09
影响因子：
2.1
通讯作者：
Li X
中科院分区：
文献类型：
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作者：
Li J;Zhao Z;Jiang H;Jiang M;Yu G;Li X
肝酶，包括丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST），是肝功能障碍和脂肪肝疾病的标志物。虽然ALT和AST已被认为是心血管疾病的危险因素，但其作为急性心肌梗死（AMI）后死亡率预测因子的作用尚未确立。本研究的目的是探讨ALT和AST对AMI患者死亡率的预测价值。我们分析了在吉林大学第一医院心血管中心治疗的712例无已知肝病的AMI患者的记录。主要结局为全因住院死亡率。采用多变量logistic回归分析评估主要结局与各种危险因素（包括血清转氨酶水平）之间的关系。年龄（P < 0.001），高血压（P = 0.034），既往心肌梗死（P < 0.001）、AST（P < 0.001），ALT（P < 0.001），肌酐（P = 0.007），血尿素氮ST段抬高型心肌梗死（STEMI）与非STEMI之间的心肌钙蛋白I（P <0.001）和心肌钙蛋白I（P <0.006）有显著性差异。以下因素与AMI患者院内全因死亡风险增加相关：ALT ≥ 2ULN（校正比值比[AOR] 2.240 [95%置信区间（CI），1.331-3.771]; P = 0.002）;年龄≥ 65岁（AOR 4.320 [95% CI 2.687-6.947]; P < 0.001）;空腹血糖（FPG）升高（AOR 2.319 [95% CI 1.564-3.438]; P < 0.001）; D-二聚体升高（AOR 2.117 [95% CI 1.407-3.184]; P < 0.001）;纤维蛋白原升高（AOR 1.601 [95%CI 1.077-2.380]; P = 0.20）;肾小球滤过率估计值（eGFR）降低（AOR 2.279 [95%CI 1.519-3.419]; P < 0.001）。我们的研究结果表明，ALT升高与AMI患者的住院全因死亡率增加独立相关。其他风险因素包括年龄、FPG、D-二聚体和纤维蛋白原增加以及eGFR降低。
Liver enzymes, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are markers of hepatic dysfunction and fatty liver disease. Although ALT and AST have been suggested as risk factors for cardiovascular disease, their role as predictors of mortality after acute myocardial infarction (AMI) has not been established. The objective of this study was to investigate the predictive value of ALT and AST for mortality in patients with AMI. We analyzed records of 712 patients with AMI and no known liver disease treated at the Department of Cardiovascular Center in the First Hospital of Jilin University. The primary outcome was all-cause in-hospital mortality. Relationships between primary outcome and various risk factors, including serum transaminase levels, were assessed using multivariate logistic regression analysis. Age (P < 0.001), hypertension (P = 0.034), prior myocardial infarction (P < 0.001), AST (P < 0.001), ALT (P < 0.001), creatinine (P = 0.007), blood urea nitrogen (P = 0.006), and troponin I (P < 0.001) differed significantly between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. The following factors were associated with an increased risk of in-hospital all-cause mortality in patients with AMI: ALT ≥ 2ULN (adjusted odds ratio [AOR] 2.240 [95% confidence interval (CI), 1.331–3.771]; P = 0.002); age ≥ 65 year (AOR 4.320 [95% CI 2.687–6.947]; P < 0.001); increased fasting plasma glucose (FPG) (AOR 2.319 [95% CI 1.564–3.438]; P < 0.001); elevated D-dimer (AOR 2.117 [95% CI 1.407–3.184]; P < 0.001); elevated fibrinogen (AOR 1.601 [95% CI 1.077–2.380]; P = 0.20); and reduced estimated glomerular filtration rate (eGFR) (AOR 2.279 [95% CI 1.519–3.419]; P < 0.001). Our findings demonstrated that elevated ALT was independently associated with increased in-hospital all-cause mortality in patients with AMI. Other risk factors were increased age, FPG, D-dimer, and fibrinogen and decreased eGFR.