Progressive liver functional impairment is associated with an increase in AST/ALT ratio

• Published in: Digestive diseases and sciences 1999-06, Vol.44 (6), p.1249-1253
• Main Authors: GIANNINI, E, BOTTA, F, FASOLI, A, CEPPA, P, RISSO, D, LANTIERI, P. B, CELLE, G, TESTA, R
• Format: Article
• Language: English
• Subjects: Adult; Alanine Transaminase - blood; Aspartate Aminotransferases - blood; Biological and medical sciences; Chronic Disease; Clinical Enzyme Tests - methods; Clinical Enzyme Tests - statistics & numerical data; Disease Progression; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - classification; Hepatitis B, Chronic - diagnosis; Hepatitis C, Chronic - blood; Hepatitis C, Chronic - classification; Hepatitis C, Chronic - diagnosis; Humans; Lidocaine - analogs & derivatives; Lidocaine - blood; Liver Cirrhosis - blood; Liver Cirrhosis - classification; Liver Cirrhosis - diagnosis; Liver Function Tests - methods; Liver Function Tests - statistics & numerical data; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Prognosis; Retrospective Studies; ROC Curve; Sensitivity and Specificity
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1023/A:1026609231094

The ratio of serum aspartate aminotransferase to alanine aminotransferase (AST/ALT ratio) has been proposed as a noninvasive method of assessing liver fibrosis and cirrhosis. Our aims were to confirm the usefulness of the AST/ALT ratio in diagnosing cirrhosis noninvasively as well as to verify the existence of a relationship between the ratio and liver functional impairment. In all, 348 patients (177 with chronic hepatitis, 171 with cirrhosis) were retrospectively evaluated and the AST/ALT ratio was related to monoethyl glycine xylidide (MEGX) formation. Moreover, in a subgroup of 54 patients we analyzed the relationships among the AST/ALT ratio and indocyanine green clearance and half-life. The AST/ALT ratio was able to separate patients with mild fibrosis from those with severe fibrosis and cirrhosis. The AST/ALT ratio, MEGX, prothrombin activity, and platelet count were selected by multivariate analysis as variables associated with cirrhosis. The AST/ALT ratio showed significant correlations both with MEGX formation and with indocyanine green clearance and half-life. The alterations of indocyanine green kinetics, which depend upon liver blood flow and uptake, were likely due to progressive fibrosis. These findings might partially explain the increase in the AST/ALT ratio as disease progresses.