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Open Access Gold as soon as Publ. Version/Full Text is submitted to ZB.
Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels.
Hepatology 50, 1403-1411 (2009)
The aim of the present study was to investigate the association of serum gamma-glutamyltransferase (GGT) levels with all-cause mortality and to assess the impact of ultrasonographic findings of hepatic hyperechogenicity in that association. We used data from 4,160 subjects (2,044 men and 2,116 women) recruited for the population-based Study of Health in Pomerania (SHIP) without baseline hepatitis B and C infections or liver cirrhosis. GGT was divided into age- and sex-dependent quintiles to calculate overall and sex-specific crude incidence mortality rates. Hepatic steatosis was defined by elevated GGT levels (>80%) and the presence of hyperechogenic liver ultrasound. We used multiple-adjusted Cox proportional hazards regression models, first, to assess the direct effect of GGT on all-cause mortality, second, to stratify according to the ultrasonographic finding, and third, to investigate potential mediating effects of cardiometabolic risk factors. During 29,810 person-years (7.3 years, median) of follow-up, 307 individuals (7.5%) died, resulting in a death rate of 0.86 deaths per 1000 person-years. Elevated GGT levels were associated with increased risk of mortality in men (hazard ratio [HR] 1.49; 95% confidence interval [CI], 1.08-2.05), but not in women (HR 1.30; 95% CI, 0.80-2.12). This association was even stronger in men with hepatic steatosis (HR 1.98; 95% CI, 1.21-3.27). Cause-specific mortality analysis by cardiovascular disease deaths confirmed the sex-specific association. Adjustment for cardiometabolic risk factors did not affect the estimates. CONCLUSION: In the case of increased GGT levels, liver ultrasound should be performed, not only for diagnosis, but also for further risk stratification.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
c-reactive protein; Cardiovascular-disease mortality; All-cause mortality; Middle-aged men; Metabolic syndrome; General-population; Pomerania ship; Transferase level; Oxidative stress; Thyroid-function
ISSN (print) / ISBN
0270-9139
e-ISSN
1527-3350
Journal
Hepatology
Quellenangaben
Volume: 50,
Issue: 5,
Pages: 1403-1411
Publisher
Wiley
Publishing Place
Hoboken, NJ
Reviewing status
Peer reviewed
Institute(s)
Institute of Epidemiology (EPI)