liver Function test ratios and cirrhosis

[Ruggerhead]

Hi Im a little confused and cant find any real answers online. When they talk about AST/ ALT ratios, is that around raised liver enzymes. For example if your AST was 20 which is well in the normal range and ALT was 15 then if you put that into ratio calculations and up pops cirrhosis, or is that ratio only when say your AST might be 100, ALT 80. Does any one know?

[DM-001]

I think you know the answer to that . No-one here can diagnose anything and its best left to the professionals.

This has been a hot topic in the past, and every indication is that within normal range it doesn't matter, but I'm not a doctor and to diagnose any sort of Liver problems, a whole range of factors and tests need to be taken into account not just a ratio of bloods.

[Ruggerhead in reply to DM-001]

thank you DM, Im not sure i do know actually, and its hard to actually find out from a professional, of course I realise that it takes many bloods etc. But then you watch things on you tube that say Oh and you can still have liver disease with normal bloods. I do have a liver disease, but i guess its just the waiting period between fibroscans etc. Maybe ill try and get other liver tests that are more specific. Than the usual function tests. I just thought someone might be able to shed a light on things.

[Kristian]

Hi Ruggerhead,

There has been lots of debate about ratios on here. Truth be told, no diagnosis will ever be made from a ratio alone, or for that matter any single blood test. Indeed ratios in isolation are almost meaningless.

They are helpful to indicate a line of inquiry where some liver injury may be suspected or possible. But in those cases there are usually other tell tale signs to go off, even if tests were in the normal range.

I never understood where this notion of such a ratio being indicative of cirrhosis comes from. I had significant cirrhosis that developed over a period of around 8 years from fibrosis right the way through to having a liver transplant. At no point in any of that time did I have an AST/ALT ratio where the AST was higher than the ALT. So if we were reliant on that ratio to get a diagnosis then by that measure I didnt have cirrhosis. So, you see, relying on a ratio is just nonsense. So dont get fixated on it.

With regards to whether a test has to be outside the normal range to matter we have to look at the statistical significance of the numbers. Where you have low numbers a small change can wildly affect any calculation. And given that the body will always naturally produce these enzymes, where numbers are low there is a higher chance of one being higher than the other naturally at any given time. So the significance of the numbers makes more sense where the numbers are higher as there is less chance it just a bit of natural variation.

Most test are done to help practitioners get to an endpoint and diagnosis in the shortest time. Very few are diagnostic in their own right. Even the standard liver function tests like ALT are not diagnostic of anything on their own.

Hope thats helpful.

[Ruggerhead in reply to Kristian]

Really helpful and well put Kristian, To be honest it is so often the people on here that know more than most. I was actually explaining to a Dr once that liver tests to monitor medication effects should not be taken as fact. I started getting my bloods done every month for about 8 months and only then did my Dr agree to send me for a Fibro-scan. I was released from hospital with what seemed from bloods to be a healthy enough liver then on Fibroscan, a shock, NAFLD- NASH. I am trying to get those numbers down, and i am being told I am a rare and unusual case given I am fit, light drinker, good diet etc. I am told my damage is not due to lifestyle or hep B/C etc so what? Did you know what caused your liver downfall?

[Kristian in reply to Ruggerhead]

Diagnosing liver disease causes can be tricky. It took a long while for me, but was eventually confirmed as Primary Schlerosing Cholangitis (or PSC for short), which is a sort of immune system related disease that primarily affects the bile ducts

[Smegmer]

I am no doctor. But I have seen hundreds of blood tests results and scan results. I had a fear like you a few years ago and I guess you have been on google ! Stop going on Google, a head ache means a brain tumour on Google !

The ratio is not relevant in a healthy person ! The last time I saw the ratio in action for real was in a 30 year HepC patient going into Liver failure !

I have taken a little look at your posting history and your Fibrosis score shows no issues, so relax ! You likely not about to die of liver failure im sure.

A fibroscan shows stiffness, each time you have been well within range. The scan can be affected if you have eaten before hand. Its a relatively new scan so they are just learning about fat etc. Its possible that it just fluctuates throughout your life without doing any serious damage, they just don't know yet.

You are seeing rises and that is worrying you, try not get too worried, you don't any signs of scarring or inflammation.

[Hidden in reply to Smegmer]

Very interesting.