Korean J Fam Pract. 2018; 8(4): 504-511  https://doi.org/10.21215/kjfp.2018.8.4.504
Association between Serum Liver Enzyme and Mortality in the Diabetes Patients of Korea
Chung-Woo Lee1, Do-Hoon Kim1,*, Seung-Hyun Lee1, Dong-Won Kim1, Hyonchong Kim1, SooGyeong Park1, Da-Eun Seul1, Joo-Hyun Park1, Shinhye Kim1, Moonyoung Choi1, Jin-Hyung Jung2, Kyungdo Han2
1Department of Family Medicine, Korea University College of Medicine; 2Department of Biostatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
Do-Hoon Kim Tel: +82-31-412-4261, Fax: +82-31-412-5364 E-mail: kmcfm@hanmail.net ORCID: http://orcid.org/0000-0001-7421-4501
Received: June 23, 2017; Revised: September 14, 2017; Accepted: September 18, 2017; Published online: August 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Serum liver enzyme levels have been commonly used as an indicator of liver damage, but recent studies have shown that gamma-glutamyl transferase (GGT), aspartate transaminase (AST), and alanine transaminase (ALT) levels may also affect all-cause mortality and cardiovascular mortality. In this study, we aimed to investigate the association between serum liver enzyme levels and mortality in patients with diabetes who were susceptible to cardiovascular disease.
Methods: In this study, using the national health insurance cohort data, we compared the mortality ratio of patients with diabetes who underwent health screening from 2003 to 2008 according to serum GGT, AST, and ALT quartiles.
Results: Of 35,996 participants, 21,946 were men, and the average age of the participants was 56 years. The average serum GGT, AST, and ALT levels of the participants were 36 IU/L, 25.9 IU/L, and 25.9 IU/L, respectively. Regarding GGT, significantly higher all-cause and cardiovascular mortality rates were observed in the fourth quartile than in the first quartile for both men and women. Regarding AST and ALT, both men and women had lower mortality rates in the second and third quartiles than in the first quartile, and both men and women had lower cardiovascular mortality in the second, third, and fourth quartiles than in the first quartile.
Conclusion: In patients with diabetes, elevated GGT levels are associated with increased mortality, while reduced AST and ALT levels to some extent may be associated with mortality, especially cardiovascular mortality. Therefore, it is necessary to pay attention to AST and ALT decreases with GGT increases in patients with diabetes.
Keywords: Liver Function Tests; Gamma-Glutamyl Transferase; Aspartate Transaminase; Alanine Transaminase; Diabetes Mellitus; Mortality
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