Lower alanine aminotransferase levels are associated with increased all-cause and cardiovascular mortality in nonalcoholic fatty liver patients

Table 4 Association of alanine aminotransferase level, all-cause, cardiovascular disease, cancer-related and others-related mortality among nonalcoholic fatty liver disease patients in men

Mortality outcome, ALT level	No. of death, n (%)	Unadjusted		Age-adjusted		Multivariate-adjusted
		HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
All-cause
< 0.5 ULN	306 (61.1)	1		1		1
0.5-1 ULN	436 (45.2)	0.60 (0.52-0.70)	< 0.001	0.69 (0.59-0.80)	< 0.001	0.68 (0.58-0.80)	< 0001
1-2 ULN	115 (30.8))	0.37 (0.30-0.46)	< 0.001	0.62 (0.50-0.77)	< 0.001	0.60 (0.47-0.76)	< 0001
≥ 2 ULN	21 (22.6)	0.26 (0.16-0.40)	< 0.001	0.69 (0.44-1.09)	0.11	0.72 (0.42-1.21)	0.214
Cardiovascular disease
< 0.5 ULN	102 (20.4)	1		1		1
0.5-1 ULN	119 (22.3)	0.50 (0.39-0.65)	< 0.001	0.58 (0.44-0.76)	< 0.001	0.57 (0.43-0.77)	< 0.001
1-2 ULN	34 (9.1)	0.34 (0.23-0.50)	< 0.001	0.58 (0.39-0.87)	0.007	0.55 (0.33-0.92)	0.022
≥ 2 ULN	3 (3.2)	0.11 (0.04-0.36)	< 0.001	0.33 (0.10-1.05)	0.06	0.51 (0.13-1.97)	0.331
Cancer
< 0.5 ULN	67 (13.4)	1		1		1
0.5-1 ULN	103 (10.7)	0.65 (0.48-0.89)	0.006	0.73 (0.54-1.00)	0.051	0.79 (0.57-1.10)	0.169
1-2 ULN	25 (6.7)	0.37 (0.23-0.58)	< 0.001	0.62 (0.39-0.99)	0.047	0.76 (0.45-1.29)	0.308
≥ 2 ULN	5 (5.4)	0.28 (0.11-0.69)	0.006	0.81 (0.32-2.05)	0.654	1.05 (0.35-3.12)	0.935
Others
< 0.5 ULN	137 (44.8)	1		1		1
0.5-1 ULN	214 (49.1)	0.81 (0.65-1.00)	0.048	0.81 (0.66-1.01)	0.058	0.73 (0.57-0.92)	0.921
1-2 ULN	56 (48.7)	0.68 (0.50-0.92)	0.014	0.75 (0.55-1.03)	0.073	0.57 (0.38-0.85)	0.851
≥ 2 ULN	13 (61.9)	0.70 (0.39-1.23)	0.212	0.76 (0.42-1.37)	0.361	0.40 (0.19-0.84)	0.844

The multivariate model was adjusted for age, sex, race/ethnicity, body mass index, waist circumference, aspartate aminotransferase, albumin, triglyceride, total cholesterol, high-density lipoprotein cholesterol, smoking status, diabetes, hypertension, and sedentary lifestyle. Others: Chronic lower respiratory diseases, accidents (unintentional injuries), cerebrovascular diseases, Alzheimer’s diseases, diabetes mellitus, influenza and pneumonia, nephritis, nephrotic syndrome and nephrosis and all other causes (residual). CI: Confidence interval; HR: Hazard ratio; ULN: Upper limits of normal; ALT: Alanine aminotransferase.