HomeAnswersMedical GastroenterologycirrhosisAST/ALT more than 1. Can this mean liver disease or cirrhosis?

Does AST/ALT more than 1 mean liver disease or cirrhosis?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At August 20, 2015
Reviewed AtJuly 24, 2023

Patient's Query

Hello doctor,

Three years ago I was diagnosed with non-alcoholic fatty liver and at that time my liver enzymes were 3 to 4 times of the upper ranges. I then lost weight and with time my enzymes got normalized. However, in last test, I have noticed a pattern where AST is greater than ALT, though they are in the normal range. AST is always greater than ALT a few points and in the last test, this increased more though the enzymes are normal. I have read the AST/ALT>1 is a sign of advanced liver disease or cirrhosis. Is this valid when the enzymes are in the normal range also? It is in the last three years that my platelet count changes in 128 to 180 range always.

Hi,

Welcome to icliniq.com.

No, the concept of AST (aspartate aminotransferase): ALT (alanine transaminase) is not valid when the enzymes are in normal range. However, low platelet count can be an early sign of liver cirrhosis. It is not very uncommon to get liver cirrhosis in cases of NAFLD (non-alcoholic fatty liver disease). I would recommend you upper GI (gastro intestinal) endoscopy to look for any varices, a sign of chronic liver disease, fibroscan of the liver. I would also advice you to get tested for hepatitis B and C, in case you have never been tested for that.

Patient's Query

Thank you doctor,

I would not worry about platelet count as the platelet count was always in range at all tests over three years. I think it is my normal count. Hepatitis B, C are negative. So far, I did three ultrasounds and one CT scan, two ultrasounds (one with doppler) were totally normal. In the last one, the report said hepatofugal flow in the hepatic veins, with flattening of the flow curve and loss of systolic flow reversal and triphasic aspect of the flow curve in the hepatic vein, pointing to increased liver stiffness. The decision was increased slightly from what is seen in steatosis, and doppler flow findings compatible with increased liver stiffness. My main question was whether the ratio of AST/ALT is important when the enzymes are in the normal range. I was worrying about this.

Hi,

Welcome back to icliniq.com.

In that case, there is no point of worrying. However, a fibroscan would be a better technique for the purpose of detecting any damage to the liver. I would say, that the images (attachment removed to protect patient identity) do not disclose the proper status of the liver as it has to be seen in all dimensions by the operator. So, I suppose, the reporting done by them must be right.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Anshul Varshney
Dr. Anshul Varshney

Internal Medicine

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