{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:05:28Z","timestamp":1785168328524,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,3,12]],"date-time":"2018-03-12T00:00:00Z","timestamp":1520812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea study","award":["HI13C0729"],"award-info":[{"award-number":["HI13C0729"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The serum alanine aminotransferase (<jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content>) level has been used to identify at\u2010risk patients with chronic hepatitis B (<jats:styled-content style=\"fixed-case\">CHB<\/jats:styled-content>) who need antiviral therapy. However, the level associated with increased liver\u2010related mortality requiring active treatment is still unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used a Health Examination Cohort of the National Health Insurance Service of Korea that included approximately 0.5 million individuals aged 40\u201079\u00a0years. In total, 12\u00a0486 patients with <jats:styled-content style=\"fixed-case\">CHB<\/jats:styled-content> and no other concurrent liver disease were enrolled, and patients\u2019 liver\u2010related mortality, including that owing to liver cancer, was investigated over 9\u00a0years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The serum <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> level was correlated positively with liver\u2010related mortality. The rates in men were 0.14, 0.17, 0.24, 0.57, 0.63 and 0.85 per 100 person\u2010years (%) for serum <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> levels of &lt;20, 20\u201029, 30\u201039, 40\u201049, 50\u201079 and \u226580\u00a0U\/L, respectively, and the corresponding liver\u2010related mortality rates in women were 0.03%, 0.09%, 0.12%, 0.63%, 0.65% and 0.32%. In patients with <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> levels of 40\u201079\u00a0U\/L, the liver\u2010related mortality rates were 0.60% in men and 0.64% in women, which were similar to the overall mortality rate of age\u2010 and sex\u2010matched subjects without <jats:styled-content style=\"fixed-case\">CHB<\/jats:styled-content> (0.69%). The best cut\u2010off values for liver\u2010related mortality prediction were &gt;34\u00a0U\/L in men and &gt;30\u00a0U\/L in women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The liver\u2010related mortality rate increased significantly, even in <jats:styled-content style=\"fixed-case\">CHB<\/jats:styled-content> patients with relatively low serum <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> levels. Careful monitoring or earlier antiviral therapy should be considered for patients aged &gt;40\u00a0years with serum <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> levels above the upper limit of normal.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13705","type":"journal-article","created":{"date-parts":[[2018,1,30]],"date-time":"2018-01-30T20:36:45Z","timestamp":1517344605000},"page":"1751-1759","source":"Crossref","is-referenced-by-count":31,"title":["Serum alanine aminotransferase level and liver\u2010related mortality in patients with chronic hepatitis B: A large national cohort study"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2497-8663","authenticated-orcid":false,"given":"Jae\u2010Jun","family":"Shim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Kyung Hee University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kyung Hee University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Hyuk","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kyung Hee University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye\u2010Rin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Kyung Hee University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Sung","family":"Lee","sequence":"additional","affiliation":[{"name":"Clinical Research Center Asan Medical Center  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So\u2010Youn","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Medical Education and Humanities Kyung Hee University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung\u2010Ho","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kyung Hee University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u2010Hwan","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Kyung Hee University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22109"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.517"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38050.593634.63"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22090"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.10.052"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2011.06.036"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.065136"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2007.06.015"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22878"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.icb.7100009"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2007.11.011"},{"key":"e_1_2_9_13_1","first-page":"370","article-title":"Clinical Practice Guidelines on the management of hepatitis B virus infection","volume":"2017","author":"EASL","year":"2017","journal-title":"J Hepatol"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28156"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-015-9675-4"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2016.22.1.18"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.02.075"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2007.07.022"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21585"},{"key":"e_1_2_9_20_1","first-page":"e15","article-title":"Cohort profile: the National Health Insurance Service\u2010National Sample Cohort (NHIS\u2010NSC), South Korea","volume":"46","author":"Lee J","year":"2017","journal-title":"Int J Epidemiol"},{"key":"e_1_2_9_21_1","unstructured":"Statistics Korea.Korean Standard Classification of Diseases and Causes of Death (KCD\u20106).2011.https:\/\/kssc.kostat.go.kr:8443\/ksscNew_web\/ekssc\/main\/main.do. 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