Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels
- 19 June 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Hepatology
- Vol. 50 (5), 1403-1411
- https://doi.org/10.1002/hep.23135
Abstract
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. (HEPATOLOGY 2009.)Keywords
This publication has 40 references indexed in Scilit:
- Longitudinal Change in Serum Gamma-Glutamyltransferase and Cardiovascular Disease MortalityArteriosclerosis, Thrombosis, and Vascular Biology, 2008
- Three-year increase of gamma-glutamyltransferase level and development of type 2 diabetes in middle-aged men and women: the D.E.S.I.R. cohortDiabetologia, 2006
- The epidemiology of nonalcoholic fatty liver disease in adults.Published by Rockefeller University Press ,2006
- γ-Glutamyltransferase as a Risk Factor for Cardiovascular Disease MortalityCirculation, 2005
- Serum γ-Glutamyltransferase and Risk of Metabolic Syndrome and Type 2 Diabetes in Middle-Aged Japanese MenDiabetes Care, 2004
- γ-Glutamyltransferase Is a Predictor of Incident Diabetes and Hypertension: The Coronary Artery Risk Development in Young Adults (CARDIA) StudyClinical Chemistry, 2003
- -Glutamyltransferase and risk of stroke: the EUROSTROKE projectJournal of Epidemiology and Community Health, 2002
- Gamma‐glutamyl transpeptidase and the metabolic syndromeJournal of Internal Medicine, 2000
- Serum Gamma-Glutamyl Transferase, Self-Reported Alcohol Drinking, and the Risk of StrokeStroke, 2000
- Gamma-glutamyltransferase: Determinants and Association with Mortality from Ischemic Heart Disease and All CausesAmerican Journal of Epidemiology, 1995