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Published on: March 7, 2013
Preoperative Alanine Aminotransferase and Postoperative ALT Elevation: A Retrospective Cohort Study
Jisun Choi1, Hyun Young Lim1, Jeayoun Kim1
1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
Abstract:
Background: Modestly elevated serum alanine aminotransferase (ALT) levels are associated with increased morbidity and mortality in the general population; however, the perioperative significance of mildly elevated preoperative ALT levels in surgical patients remains unclear. Methods: This retrospective cohort study included adults undergoing non-hepatic, non-cardiac surgery at Samsung Medical Center. Patients with preoperative ALT measured within 3 months and <2 times the upper limit of normal (ULN) were eligible. Preoperative ALT was categorized as lower (men 0-34 U/L; women 0-22 U/L) or higher (men 35-82 U/L; women 23-66 U/L). The primary outcome was marked postoperative ALT elevation, operationally defined as any postoperative ALT value > 5 times the institutional ULN within 21 days after surgery. Propensity score matching was performed. Secondary outcomes included long-term ALT elevation, defined as an increase from the preoperative ALT value to >2 times the ULN at the last available measurement within 1 year after surgery, and 1-year all-cause mortality. Results: Among 43,892 patients, 7740 (17.6%) were classified into the higher ALT group, and marked postoperative ALT elevation occurred in 733 patients (1.7%). After 1:1 propensity-score matching, 7660 patient pairs were analyzed, and marked postoperative ALT elevation occurred more frequently in the higher than in the lower ALT group (2.7% [204/7660] vs. 1.6% [121/7660]; OR 1.72, 95% CI 1.36-2.16; p < 0.001). Higher preoperative ALT was also associated with long-term ALT elevation (OR 4.96, 95% CI 3.65-6.74; p < 0.001) and increased 1-year mortality (5.4% vs. 4.4%; OR 1.25, 95% CI 1.08-1.45; p = 0.003). Conclusions: Higher preoperative ALT was associated with marked postoperative ALT elevation, long-term ALT elevation, and 1-year mortality, even within the conventional normal range. Preoperative ALT may therefore warrant consideration when evaluating postoperative risk.