I hope all is well. I recently got Bloodwork done after several years not getting Bloodwork. In the past, I drank a lot in college (I'm a 31 year old male, 200 pounds, 5' 11). All bloodwork looked fine. I always pay attention to the AST/ALT numbers due to my past heavy drinking history. Last time I got bloodwork, my Bilirubin was 0.6, AST was 19 and ALT was 13. At the time, I asked my doctor, she said she saw nothing at all concerning, and that Deritis only comes into play if the AST/ALT numbers are abnormal.
I am a little concerned now, as I went out on Tuesday this week, had 3 drinks and then Thursday (the night before but I was on a date, stupid me), followed by getting Bloodwork 12 hours later. My numbers came in with AST 23, ALT 13 Bilirubin 0.8.
Any concerns with these numbers? I am assuming by default, that drinking several days prior did indeed increase the AST slightly, its probably closer to 19 or 20 based on the last time I got bloodwork. What does concern me is the DeRitis ratio of 1.7. My doctor will not order me an ultrasound as she does not believe it's neccessary, any thoughts? Are these bad numbers?
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MrGee91
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In any case, I would be concerned to see the ratio changed. It would be strange to think that the ratio works in one case and does not work in another. This contradicts the very nature of the concept of ratio in my opinion. But of course, your doctor has a professional opinion on this issue. Apparently your body resists alcohol and yet quietly says that it's uncomfortable after alcohol. The only correct advice in such a situation is to completely stop drinking.
AST is also produced by the heart, kidneys, muscles so it is less specific to the liver. The main thing is that your numbers are all well within normal. Your Dr is correct - the ratio is only relevant when results are outside the normal range. In that case, it can help guide diagnostic thinking. If you are drinking excessively and that is causing anxiety, best to think hard about it and cut down or quit.
MrGee, I posed the same question a while back, I also asked a couple of very highly respected liver consultants and the answer they gave me was this, that ratios do not apply when your liver bloods are within normal ranges, it is not of concern. If you looked at google they say that if your AST/ALT ratios are not a certain way around it can indicate end stage liver issues, but thats not what I have heard, for some people their AST is naturally slightly higher than ALT, but may have been that way for years, So from your blood tests alone yours look to be healthy levels, but all Liver function tests need to be read to ascertain patterns of potential damage ie GGT, Alk Phos etc etc not just AST/ALT ratios. If your worried get a fibroscan, very easy way to check fat buildup and stiffness.
Great to hear. I have asked the same question in the past. Like 8 years ago mine was like 23 and 8 or something and then my AST is always higher but usually closer to 2-1. Usually levels well within normal ranges....last time it was 20 and 13.
Not as far as I know. I have not gotten a liver biopsy. I got to where I felt bloated after eating so I stopped drinking almost two years ago and cut down on sodium and sugar after that and have felt good most of the time. I was just looking...July of 21 I had 21/10 and July of 22 20/13. I usually re-worry after seeing the #s, come here and ask again, and then forget about it for a year.
MrGee, if you look up some stuff on tube they usually say that to have cirrosis or severe liver issues the ratios would be based on AST and ALT figures in their hundreds, that is why unless you had other obvious symptoms then ALT/AST and other indicators in a normal LFT would also be showing poor liver function. Can you have normal bloods with end stage, yes you can by my readings, but you would know something else is up, not just ratio, try other ratios also, and maybe get a fibrascan that is the best way to know.
Hi I think you are over thinking things, can I ask why you went drinking just before your bloods? Was it to prove to yourself the effect of alcohol on the liver? Well done you have shown that it does ( not that it’s was not a hard scientific fact already!) I suggest in future you concentrate on keeping your liver healthy. Good luck.
Thanks everyone, I do appreciate everyone's replies here.
I feel like I'm fine, but my body knows about my previous experience abusing alcohol. Think I'm gonna give it a break and make sure I avoid alcohol for a while. Maybe I'll retest in 4 - 5 months time just for peace of mind. I can't see how AST would not drop with 3 4 months without drinking, last time I did 6 weeks it was 19 and 15 so I'm sure 4 5 months it will be around there or potentially even better.
I do appreciate everyone taking the time to reply!
AST and ALT ratio only applies (in 99 percent of cases) when the numbers are above normal. If it's 300 over 200 you worry. If it is 30 over 20 you don't worry. I can't make it any simpler than that.
That is why your doctor is not concerned. There is no need for you to do those tests, you will be taking up space from someone who really needs the test done.
Well said Ken, I keep trying to tell people this but they come back with, my AST is 27 and my ALT is 21 should i be concerned as the ratio is above 1 in the wrong direction. It does not matter, those ranges are good. If you are a male and your ALT is below 30 that is great news actually, Ken is right if those numbers were AST in the hundreds and ALT in the hundreds thats when they would have a closer look at the ratios, even then it might be an acute rise due to medications, drink etc
An important consideration when evaluating the risk of hepatic fibrosis is that both AST and ALT can be normal even in the setting of cirrhosis, and the utility of the AST:ALT ratio in adults persists even if both values are within the normal reference interval
Hi Clown, is it possible to provide a link to which guidelines you've seen this in? From all the reading i've done over the years I know that AST and ALT can be normal in people who have cirrhosis but i've never seen anything that gives relevance to the De Ritis Ratio other that if levels are elevated above upper limit of normal OR in the case of known chronic liver disease to establish a possible cause.
Just interested in knowing the source in case my information is out dated.
Thanks for that, that is a reworked set of guidance so worth seeing - page is entitled "Guidelines on the management of abnormal liver blood tests".
To put it in full context - that exerpt is including in a chapter which reads.
"Recommendation 1: Initial investigation for potential liver disease should include bilirubin, albumin, ALT, ALP and GGT, together with a full blood count if not already performed within the previous 12 months. (level 2b, grade B)
If there is clear indication of a specific clinical risk—for example, in high-risk groups such as injecting drug users, migrants from high prevalence areas or prisoners, then some aspects of second-line testing can be undertaken simultaneously. In many patients with liver damage an assessment of liver fibrosis is critical in making decisions about referral and management. In adults, clues to the level of liver fibrosis can be gleaned from the use of non-invasive algorithms such as the AST to ALT ratio.12 An AST:ALT ratio of >1 indicates advanced fibrosis/cirrhosis, hence the inclusion of this ratio in algorithms has the potential to assess the risk of significant fibrosis in adults with abnormal liver blood tests. However, non-invasive markers have not been sufficiently validated in children to be routinely applied in clinical practice.
An important consideration when evaluating the risk of hepatic fibrosis is that both AST and ALT can be normal even in the setting of cirrhosis, and the utility of the AST:ALT ratio in adults persists even if both values are within the normal reference interval. While it is hard to justify the routine analysis of both AST and ALT together on every liver blood test request, a strategy not supported by the data from the BALLETS study, subsequent testing of AST (or ALT depending which one is undertaken first) to calculate the AST:ALT ratio is clearly desirable. From a patient and cost perspective this is likely to be more cost-effective if performed by ‘reflex’ on the same sera following the detection of an abnormal ALT or GGT. To date there is no firm evidence that this is a cost-effective approach, although the results of a pilot study of such ‘reflex’ testing and additional up-front aetiology screen testing from Wales and Scotland are awaited."
Funny, but the source for that (marked as 39 - and I link it below) only talks about ALT, says nothing about the ratio and says nothing about cirrhosis. The survey is more than 10 years old too.
Hundreds of studies and articles and tests and surveys have been done and with this one exception all say AST and ALT should only be calculated when two to three times higher than they should be. I will trust them not one outlier.
I just had my heptologist visit this week and I had a level of AST 16, ALT 15 and my Dr said these are normal limits and healthy numbers and that’s what he said after I asked about the Ratio. Said keep them there .
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