I read online that an AST/ALT ratio greater than 1.2 can mean advanced liver disease. On August 9 I had a liver enzyme blood test done and all the results were well within normal; however, when I used an AST/ALT calculator tool online, it said I had a ratio score of 1.4 and that this could mean serious liver fibrosis or cirrhosis. I've attached a screenshot if the results and would appreciate any input. Oh, I used another online calculator tool for Fib-4 (using AST, ALT & platelet count) and it showed a score if 0.42, which was very minimal seriousness. Which test is more reliable as an indicator of severity?
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ToughToes
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Hello, I’m not a doctor but I assume that the ratio is only relevant when your enzymes are outside the normal range. In case your levels are okay I wouldn’t be worried about the ratio at all😉
I was told the ratio only applies when both are pretty far out of range and even then, they investigate further. Platelet count is more important as far as I know.
The AST/ALT ratio can be useful even where enzymes are otherwise in range, but it is not used on its own for any diagnosis, certainly not for fibrosis.
A ratio well above 1, for example, can indicate alcoholic liver disease, even where fibrosis is low. That is because long-term alcohol abuse can damage liver cell mitochondria and how the liver produces and processes both AST and ALT. In a healthy person, the ratio will tend towards 1 (but can be within a range--1.2 or .8 can be perfectly normal, there is no magic cutoff). If the ratio approaches 2, and there is a history of alcohol abuse, a high ratio probably indicates some form of alcoholic liver disease/damage.
A ratio of 1.4, with no other troubling history, and no other symptoms, is probably nothing to worry about.
You're getting some misleading statements on the other forum about the ratio about the AST/ALT ratio being meaningless unless enzymes are elevated. Note, those claims are never supported by peer reviewed articles. If you are on twitter/x, you can check the link below doctor/scientist's explanation of why the ratio is useful in identifying alcoholic liver damage (try to read the whole thread of 14 posts, it is well researched and supported, I just linked to the conclusion/summary). It has to do with the rate at which AST and ALT are produced and cleared in a healthy liver versus one with damaged mitochondria (which is where cells process energy/etc). A liver damaged by alcohol functions differently, and that difference can be reflected in a high ratio, even if there is no current high level of inflammation that would lead to elevated enzymes.
A ratio of 1.4 might not mean anything, if you don't have a history of long-term alcohol abuse. Even if you do, the ratio itself won't be enough to diagnose cirrhosis, or fibrosis, and is no reason to panic. That is not its purpose. But, the ratio absolutely can be a sign of damaged liver cells in the setting of chronic alcohol abuse. Doctors should use it to identify patients who are possibly problem drinking *before* their livers fail. The AST/ALT ratio is misunderstood and underutilized.
This article has some interesting stats regarding AST and ALT means, ratios, and average Fib-4 scores in a large sample of non-drinkers. Yours seem well within general averages, and the ratio is within the normal standard deviation.
Your value of less than 1.3 indicates that you do not have significant fibrosis, but like all these tests, they have to be interpreted in light of all of your medical values as none of them are perfect.
The AST/ALT ratio, also known as the De Ritis ratio, is used in clinical practice to help differentiate between different causes of liver dysfunction. The sensitivity of the AST/ALT ratio varies depending on the specific liver condition being investigated:
Alcoholic Liver Disease: In alcoholic liver disease, the AST/ALT ratio is often greater than 2. The sensitivity of this ratio for diagnosing alcoholic liver disease can be high, especially when combined with other clinical findings and laboratory tests. However, it is not perfectly sensitive or specific on its own.
Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): In these conditions, the AST/ALT ratio is usually less than 1. The sensitivity of the ratio for diagnosing NAFLD or NASH is lower compared to alcoholic liver disease, as many other conditions can also present with a low AST/ALT ratio.
Viral Hepatitis: In cases of viral hepatitis, the ALT level is typically higher than AST, resulting in a ratio of less than 1. The sensitivity in this context is moderate, but again, the ratio is not used in isolation for diagnosis.
Other Liver Conditions: The AST/ALT ratio can also be altered in other liver conditions such as cirrhosis or liver fibrosis, but its sensitivity and specificity vary widely.
Overall, while the AST/ALT ratio can provide useful information, it should not be used as a standalone diagnostic tool. It is most effective when used in conjunction with other clinical evaluations, laboratory tests, and imaging studies. For accurate diagnosis and assessment, healthcare providers consider the ratio as part of a broader diagnostic workup.
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