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

Table 5 Association of alanine aminotransferase level, all-cause, cardiovascular disease, cancer-related and others-related mortality among nonalcoholic fatty liver disease patients in women

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	144 (34.0)	1		1		1
0.5-1 ULN	440 (38.8)	1.16 (0.96-1.40)	0.127	0.88 (0.73-1.06)	0.176	0.91 (0.74-1.10)	0.348
1-2 ULN	187 (36.0)	1.05 (0.85-1.31)	0.632	0.83 (0.67-1.03)	0.095	0.76 (0.60-0.97)	0.027
≥ 2 ULN	46 (30.7)	0.89 (0.64-1.24)	0.484	1.10 (0.79-1.53)	0.585	0.82 (0.52-1.31)	0.416
Cardiovascular disease
< 0.5 ULN	41 (9.7)	1		1		1
0.5-1 ULN	119 (10.5)	1.10 (0.77-1.58)	0.594	0.82 (0.58-1.17)	0.282	0.86 (0.59-1.26)	0.44
1-2 ULN	442 (8.1)	0.83 (0.54-1.28)	0.41	0.65 (0.42-1.00)	0.051	0.62 (0.38-1.02)	0.061
≥ 2 ULN	99 (6.0)	0.61 (0.30-1.26)	0.182	0.78 (0.38-1.61)	0.504	0.85 (0.29-2.43)	0.756
Cancer
< 0.5 ULN	31 (7.3)	1		1		1
0.5-1 ULN	97 (8.6)	1.18 (0.79-1.77)	0.425	0.93 (0.62-1.40)	0.728	1.02 (0.66-1.57)	934
1-2 ULN	37 (7.1)	0.96 (0.60-1.55)	0.877	0.76 (0.47-1.23)	0.261	0.83 (0.49-1.44)	0.482
≥ 2 ULN	15 (10.0)	1.34 (0.72-2.48)	0.352	1.38 (0.74-2.57)	0.309	1.49 (0.61-3.68)	0.395
Others
< 0.5 ULN	71 (49.7)	1		1		1
0.5-1 ULN	224 (50.9)	0.91 (0.70-1.20)	0.526	0.92 (0.71-1.20)	0.549	0.89 (0.67-1.18)	0.411
1-2 ULN	108 (57.8)	1.01 (0.75-1.37)	0.935	1.08 (0.80-1.46)	0.627	0.85 (0.61-1.20)	0.366
≥ 2 ULN	22 (47.8)	0.99 (0.62-1.61)	0.978	1.16 (0.72-1.88)	0.548	0.62 (0.30-1.29)	0.199

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.