Confused! De ritis 1.3 but Fib4 0.7

[Liberty82]

Hi all, I'd just like a bit of info if anyone knows about these tests. My AST is 17 and my ALT 13 which give me a de ritis score of 1.3 which is indicative if cirrhosis, however, my Fib4 result was 0.71 which is F0-1. Does the de ritis still matter if the bloods are within range? I do suffer from some symptoms. Thanks for any replies x

[nash2 Partner]

Well Liberty, those are really questions for your doctor as we can't provide medical advice but think of those tests as probabilities. They are used as ways to consider what next steps might be indicated. In general, with low enzyme levels the De ritis ratio, or the AST/ALT ratio, isn't very useful. The Fib-4 isn't diagnostic but your level is low which suggests, but doesn't prove, that you don't have NASH. For what it is worth, there are a variety of things that can cause symptoms and can be confusing but with those values your doc is probably considering other things but ask plenty of questions.

Wayne

[Liberty82 in reply to nash2]

Thanks Wayne, I really appreciate your reply x

[billelnazir]

Hi liberty82 I checked your posts and I'm currently in the exact position.

Long story short, I'm a 28yo male from France, and I've been drinking HEAVILY from 18 to 28 years old, in September 2019 I started having pain in my RUQ area, so I stopped drinking right away (9 month totally sober next week) and went to my GP and did some blood test that went back all normal (with 310 platelets, normal bilirubin, normal albumin).

At this point I just tought that the pain was due to my excessive alcohol consumption and that it will go away with time being off the booze... well it did not and I started having an itchy skin from February 2020 with some annoying bile taste in my mouth.

From February to May I just dealt with the symptoms, I was intensely stressed and depressed about my situation, spending hours on google looking for cirrhosis information. At the end of the confinment in Paris, persuaded to have cirrhosis I went straight to a GI/Hepatologist asking for blood test and an ultrasound scan, that went back all normal, also FIB-4 score 0.44

Instead of being reassured with that I did the mistake to spend hours on google again reading that one could have cirrhosis with normal blood test and that US scan could miss cirrhosis, and it just exacerbated my anxiety and my symptoms.

I literaly begged my hepatologist for a fibroscan but he wasnt OK as all my tests were normal so went to an another hepatologist that finally accepted to book me for a fibroscan.

Fibroscan score : 4.8 Kpa, IQR : 1.2

Since the fibroscan I accepted that my symptoms were not related to my liver and stopped going on google (trying to convince myself that I had aliver disease), my anxiety and my symptoms drasticly decreased.

Conclusion, like you I may have something wrong going on in my body but its certainly not a end stage disease so just relax and stop to split hairs, it will help with the symptoms I guarentee.

Sorry for the long post, cheers.

[Amethyst91 in reply to billelnazir]

I would like to reply to both of you as I am in the same boat. I’m a small 28 year old female who’s been drinking way more than I should have been since about 18. In May I got all sorts of symptoms after a heavy night of drinking. I’ve had constant URQ pain that goes all over the right side of my body from my rib area to my shoulder and neck, I even have low back pain and groin pain in the right side. I’ve always asked the drs to check my liver cuz I knew I was a drinker and could have damage and for years the only slightly elevated enzyme was bilirubin. I’ve had pale stools for 5 years or more and all my tests just show IBS(so nothing). I got a bit nauseated after May and started itching two years ago. My inner eye corners look a tiny bit yellow but no dr has commented negatively when I point them out. My ultrasound in May showed mild fatty liver which isn’t surprising with how horribly I was eating (French fries all the time and chips) and drinking. My ct even showed enlarged liver but several drs have said that’s due to a slight fatty build up and I have an extra variant on the right side of my liver. After 6 months of tests everything checks out completely normal besides a bit of fatty liver. My ast and alt are 18-20. Bilirubin in range now, and my ELF score was F0 with no inflammation seen. Finally I got a fibroscan which again shows a kpa of 3.8, iqr of 1.8, and a cap of 246. So I really just need to work on my diet and cut the alcohol is all my drs say since everything checks out fine. It’s been six months of healthy living and I still have pain and itching everyday. Im just trying to accept that there’s nothing seriously wrong with me and all I need is a lifestyle change and my fatty liver will hopefully go away. It’s very difficult though because I’ve never felt like this in my life and it gives me anxiety everyday. I guess I just need to be happy and great full I didn’t do worse to myself.