If You Have Cirrhosis, How High Are Your Liver Enzymes?

High levels of aminotransferases (AST and ALT) in the blood can indicate cirrhosis, a condition where the liver is damaged and leaking these enzymes. Laboratory findings suggestive of cirrhosis include Albumin AST > ALT, INR > 1.2, and Bilirubin > 1.5 mg/dL. The AST/ALT ratio is an indicator of cirrhosis in patients, but high levels >1000 IU/L are usually not seen in patients with cirrhosis. Aminotransferases can be moderately elevated in chronic liver disease but are often normal in advanced cirrhosis.

High levels of both ALT and AST in the blood are usually low, and they may indicate a person’s liver is not functioning properly. Common causes include fatty liver disease and cirrhosis. Patients with cirrhosis often have normal or slightly elevated serum AST and ALT levels, as AST and ALT lack some sensitivity in these tests.

If a blood test shows high levels of liver enzymes, treatment may be necessary due to either liver disease or medication. The pattern of enzyme elevations can suggest the type of liver disease present and may also indicate whether there is viral hepatitis.

What are alarming liver enzyme levels?

• Typically the range for normal AST is reported between 10 to 40 units per liter and ALT between 7 to 56 units per liter.
• Mild elevations are generally considered to be 2-3 times higher than the normal range.
• In some conditions, these enzymes can be severely elevated, in the 1000s range.

What Are Elevated (High) Levels of AST and ALT?. Elevated levels of liver enzymes in general signify some form of liver (or hepatic) damage or injury.

• These levels may be elevated acutely (short term) indicating sudden injury to the liver, or they may be elevated chronically (long term) suggesting ongoing liver injury.
• In addition to the duration, the level of abnormal elevation of the aminotransferases is also significant.
• In some conditions the elevation could be mild, consistent with a mild injury or inflammation of the liver.
• They can also be severely elevated, possibly up to 10 to 20 times the normal values, suggesting more significant damage to the liver.

How high are AST and ALT in cirrhosis?

The laboratory assessment of patients with suspected or clinically obvious liver diseases is context-dependent, with the sequence of tests depending on the questions being asked. For example, a well patient with a history of prolonged alcohol ingestion may require a different assessment than a jaundiced patient with a history of prolonged alcohol ingestion. The sequence of liver tests depends on the questions being asked, such as detecting iron overload or hepatitis B infection.

Generic algorithms for evaluating liver disease need to be considered skeptically. This chapter discusses a useful way of thinking about liver tests, emphasizing the limitations and alternative explanations for isolated abnormalities of common test results. It provides information on the initial screening test to be chosen, their interpretation, and the tests needed to confirm the diagnosis of common liver disorders based on current recommendations.

Isolated abnormalities in liver test results are common, often obtained when a bundle of tests has been done for other reasons. Guidelines on the interpretation and evaluation of abnormal liver test results have been published, and useful algorithms are presented that parallel the recommendations in this chapter.

Is 200 a high liver enzyme count?

Determination of Specific Liver Disorders. Acute Alcoholic Hepatitis. Acute alcoholic hepatitis may be mild or life threatening. The pattern of liver test abnormality is hepatocellular. The AST is typically in the 100 to 200 IU/L range, even in severe disease, and the ALT level may be normal, even in severe cases. The AST level is higher than the ALT level, and the ratio is greater than 2:1 in 70% of patients. A ratio greater than 3 is strongly indicative of alcoholic hepatitis. An important corollary is that an AST greater than 500 IU/L or an ALT greater than 200 IU/L is not likely to be explained by acute alcoholic hepatitis—even in an alcoholic patient—and should suggest another etiology.

The degrees of bilirubin level increase and prothrombin time elevation are better indicators of severity of disease. In alcoholic hepatitis, the Maddrey discriminant function (MDF), a disease-specific prognostic score which indicates the severity of liver injury, has been developed. The formula to calculate the score is as follows:

MDF = 4. 6 (patient’s prothrombin time − control prothrombin time) + total bilirubin (mg/dL)

Can you have good liver enzymes and still have cirrhosis?

Abnormal LFTs often, but not always, indicate that something is wrong with the liver, and they can provide clues to the nature of the problem. However, normal LFTs do not always mean that the liver is normal. Patients with cirrhosis and bleeding esophageal varices can have normal LFTs. Of the routine LFTs, only serum albumin, bilirubin and prothrombin time (PT) provide useful information on how well the liver is functioning.

The general subject of LFTs 1, 2 and the differential diagnosis of abnormal LFTs in asymptomatic patients 3 – 5 have been well reviewed. This article discusses some common pitfalls in the interpretation of LFTs. Hints for interpreting these tests are presented in Table 1.

The most commonly used markers of hepatocyte injury are aspartate aminotransferase (AST, formerly serum glutamic-oxaloacetic transaminase (SGOT)) and alanine aminotransferase (ALT, formerly serum glutamate-pyruvate transaminase (SGPT)). While ALT is cytosolic, AST has both cytosolic and mitochondrial forms.

Is ALT 200 a need for concern?

Our ALT shows up high whenever our liver is dealing with any infection or poison or even a hard to digest food such as fried meat. It is common for them to be high in people who have recently had alcohol or paracetamol. With infections, and these can be other diseases like flu or an septic wound they go up as the liver fights back. If they are constantly in the 50 to 200 range we term the hepatitis B infection active. ALT’s range from 0 up to 3000 or so in many acute hepatitis cases. They change with every meal so it is important not to panic if they go from 20 to 45 after a few months. All scores below 45 indicate a perfectly healthy score.

GGT (gamma glutamyl transpeptidase) is elevated in those who use alcohol or toxins.

Our GST shows up high between 50 and 200 if we are often taking paracetamol or using alcohol a lot. It is often a sign of alcoholism or longer term liver damage, but can be reversed by adopting a alcohol free or toxin free lifestyle.

Does high ALT mean cirrhosis?

In general, high levels of ALT may be a sign of liver damage from hepatitis, infection, cirrhosis, liver cancer, or other liver diseases. The damage may also be from a lack of blood flow to the liver or certain medicines or poisons.

What is an ALT Blood Test?. An ALT test measures the amount of ALT in your blood. This test is commonly used to help diagnose liver damage or disease.

ALT (alanine transaminase) is an enzyme, a protein that speeds up certain chemical reactions in your body. It is found mainly in your liver. Usually, you will have low levels of ALT in your blood. But when liver cells are damaged, they release ALT into the bloodstream. High levels of ALT in your blood may be a sign of a liver injury or disease. Some types of liver disease cause high ALT levels even before you have symptoms of the disease. So, an ALT blood test may help diagnose certain liver diseases early, when they may be easier to treat.

An ALT test is usually ordered as part of a group of liver function tests.

Is 500 high for liver enzymes?

The AST:ALT ratio is a commonly used measure of liver disease, particularly in cases of alcoholic liver disease. A 1979 study found that 90% of patients with AST:ALT 2 had alcoholic liver disease, while 96 of those with AST:ALT 3 had the same condition. This is due to the mitochondrial toxin nature of alcohol and its low absorption of pyridoxal phosphate. AST is found in both mitochondria and cytoplasm, while ALT is found in cytoplasm but not mitochondria. ALT synthesis is more dependent on pyridoxal phosphate than AST. In alcoholic liver disease, ALT is typically 500 IU/L. AST:ALT 1 can be seen in cases of liver cirrhosis. GGT 2 × the ULN suggests alcohol abuse when paired with AST:ALT 2, but alone is not a specific indicator. Mild elevations in aminotransferases are common in clinical practice and are often caused by medications, alcohol use, and chronic liver diseases. It is recommended for patients with mild increases in AST and ALT to undergo repeat testing. Moderate and severe elevations are attributed to acute exacerbations of chronic liver diseases, drug-induced liver injury, and ischemic liver injury.

Is AST or ALT higher in alcoholics?

Fernando De Ritis first described the ratio between serum levels of aspartate transaminase (AST) and alanine transaminase (ALT) almost 50 years ago. This ratio was initially used to identify acute viral hepatitis, where ALT was usually higher than AST, and later found useful in alcoholic hepatitis, where AST was usually higher than ALT. However, these interpretations are simplistic, as acute viral hepatitis can have AST greater than ALT, signifying fulminant disease, and alcoholic hepatitis can have ALT greater than AST when several days have elapsed since alcohol exposure. The ratio represents the time course and aggressiveness of disease predicted from the relatively short half-life of AST (18 h) compared to ALT (36 h). In chronic viral illnesses, such as chronic viral hepatitis and chronic alcoholism, an elevated AST/ALT ratio is predictive of long-term complications including fibrosis and cirrhosis.

Methodological issues, particularly the use of pyridoxal phosphate in transaminase assays, can have specific effects when patient samples are deficient in this vitamin. Ideally, laboratories should use pyridoxal phosphate supplemented assays in alcoholic, elderly, and cancer patients who may be pyridoxine deplete. All laboratories reporting abnormal ALT should also report AST and calculate the De Ritis ratio, as it provides useful diagnostic and prognostic information.

What liver enzyme levels indicate cirrhosis?

The following tests are used to assess liver health:

• Alanine transaminase (ALT) and aspartate transaminase (AST): These enzymes help break down protein and amino acids. High levels may indicate liver damage from cirrhosis or another disease.
• Albumin test: Albumin is a protein produced by the liver, and when damaged, it falls in blood. Bilirubin level: Bilirubin builds up in the blood, causing jaundice. High creatinine level indicates kidney damage, which can occur in the late stages of cirrhosis.
• Prothrombin time (INR): The liver produces substances that help blood clot, and a slow clotting rate may indicate cirrhosis.
• Sodium blood test: A low sodium level may indicate cirrhosis.

The results of these tests can help determine the extent of liver damage and the need for a liver transplant. A complete blood count (CBC) checks red and white blood cells and platelets for overall health. A viral hepatitis blood test checks for hepatitis A, B, and C.

• Tests for autoimmune hepatitis, Wilson’s disease, hemochromatosis, and other diseases can also be conducted.

Is ALT normal in cirrhosis?

Liver disease can still occur in patients with normal liver chemistry, even after lowering the threshold for a normal ALT value. Studies have shown that patients with nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis and a normal ALT have no significant difference in inflammation, ballooning, or fibrosis on liver biopsy when compared with patients with elevated ALT. Another study found histological disease activity in 14 to 40 patients with chronic hepatitis B infection and persistently normal ALT. When updated ULNs for ALT cutoffs were used as advocated by AASLD guidelines, a significant minority of these patients were still found to have histologically active disease.

ALT is an imperfect biomarker for identifying histological inflammation and can be normal in patients with cirrhosis. Hepatitis C screening guidelines recommend testing all baby boomers irrespective of risk factors or ALT levels. In the most recent AASLD guidance document on fatty liver disease, patients with NAFLD with metabolic syndrome or potential fibrosis based on noninvasive tests are recommended to be considered for liver biopsy.

Another example is patients undergoing bariatric surgery, which are almost universally affected by NAFLD but only a portion will experience steatohepatitis and progressive fibrosis. An elevated ALT is one potential marker of steatohepatitis. The area under the curve (AUC) for ALT in discriminating bariatric patients with steatohepatitis versus bland fat was 0. 65, whereas the ideal clinical test would have an AUC close to 1. 0.

What enzyme is elevated in liver cirrhosis?

Aminotransferases (AST and ALT) can be moderately elevated in chronic liver disease, but are often normal in advanced cirrhosis. Usually, ALT is higher than AST, but if alcohol is the main contributor to cirrhosis, this ratio can be reversed with the concentration of AST being over twice that of ALT.

Alkaline phosphatase is often elevated in cirrhosis. Higher concentrations are seen in patients with cirrhosis secondary to cholestatic disease, such as primary sclerosing cholangitis and primary biliary cholangitis.

Gamma-glutamyl transferase is also raised in cholestatic liver disease but is less specific. The most significant confounder is alcoholic liver disease (recent or chronic alcohol ingestion) which can significantly increase the concentration.