Abstract
The ratio of serum aspartate aminotransferase toalanine aminotransferase (AST/ALT ratio) has beenproposed as a noninvasive method of assessing liverfibrosis and cirrhosis. Our aims were to confirm the usefulness of the AST/ALT ratio in diagnosingcirrhosis noninvasively as well as to verify theexistence of a relationship between the ratio and liverfunctional impairment. In all, 348 patients (177 with chronic hepatitis, 171 with cirrhosis) wereretrospectively evaluated and the AST/ALT ratio wasrelated to monoethyl glycine xylidide (MEGX) formation.Moreover, in a subgroup of 54 patients we analyzed the relationships among the AST/ALT ratio andindocyanine green clearance and half-life. The AST/ALTratio was able to separate patients with mild fibrosisfrom those with severe fibrosis and cirrhosis. The AST/ALT ratio, MEGX, prothrombin activity,and platelet count were selected by multivariateanalysis as variables associated with cirrhosis. TheAST/ALT ratio showed significant correlations both with MEGX formation and with indocyanine greenclearance and half-life. The alterations of indocyaninegreen kinetics, which depend upon liver blood flow anduptake, were likely due to progressive fibrosis. These findings might partially explain theincrease in the AST/ALT ratio as diseaseprogresses.
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REFERENCES
Cohen JA, Kaplan MM: The SGOT/SGPT ratio-an indicator of alcoholic liver disease. Dig Dis Sci 24:835–838, 1979
Correia JP, Alvaes PS, Camilo EA: SGOT/SGPT ratios. Dig Dis Sci 26:234, 1981
Gitlin N: The serum glutamic oxaloace tic transaminase /serum glutamic pyruvic transaminase ratio as a prognostic index in severe acute viral hepatitis. Am J Gastroenterol 77:2–4, 1982
Williams ALB, Hoofnagle JH: Ratio of serum aspartate to alanine aminotransfe rase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology 95:734–739, 1988
Teran JC, Bashour FN, Sondhi SS, Mullen KD: Validation of a discriminant score for the diagnosis of cirrhosis in patients with chronic hepatitis. Gastroenterology 108:A1185, 1995
Bonacini M, Hadi G, Govindarajan S, Kindsay KL: Utility of a discriminant score for diagnosing advanced fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol 92:1302–1304, 1997
Sheth SG, Flamm SL, Gordon FD, Chopra S: AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol 93:44–48, 1998
Wakim KH, Fleisher GA: The fate of enzyme s in body fluid-An experimental study. II. Disappearance of glutamic-oxaloacetic transaminase I under various conditions. J Lab Clin Med 61:98–106, 1963
Fleisher GA, Wakim KH: The fate of enzyme s in body fluid-An experimental study. III. Disappe arance of rates of glutamicoxaloace tic transaminase II under various conditions. J Lab Clin Med 61:107–119, 1963
Kanimoto Y, Horiuchi S, Tanase S, Morino Y: Plasma clearance of intravenously injected aspartate aminotransferase isozymes:evidence for prefe rential uptake by sinusoidal liver cells. Hepatology 5:367–375, 1985
Burdelski M, Oellerich M, Lamesch P, Raude E, Ringe B, Neuhaus P, Bortfeld S, Kammerling C, Raith H, Scheruhn M, Westphal C, Worm M, Pichlmayr R: Evaluation of quantitative liver function tests in liver donors. Transplant Proc 19(5):3838–3839, 1987
Oellerich M, Hartmann H, Ringe B, Burdelski M, Lautz H-U, Pichlmayr R: Assessment of prognosis in transplant candidates by use of the Pugh-MEGX score. Transplant Proc 25( 1):1116–1119, 1993
Shiffman ML, Luketic VA, Sanyal AJ, Duckworth PF, Purrdum III PP, Contos MJ, Mills AS, Edinboro LE, Poklis A: Hepatic lidocaine me tabolism and liver histology in patients with chronic hepatitis and cirrhosis. Hepatology 19:933–940, 1994
Testa R, Caglieris S, Risso D, Arzani L, Campo N, Alvarez S, Giannini E, Lantieri PB, Celle G: Monoethylglycinexylidide formation measurement as a hepatic function test to assess severity of chronic liver disease. Am J Gastroenterol 92:2268–2273, 1997
Testa R, Borzone S, Risso D, Bardellini E, Caglieris S, Campo N, Lantieri PB, Celle G: Formation kinetics of the lidocaine me tabolite (MEGX) in patients with chronic active hepatitis and cirrhosis. Eur J Gastroenterol Hepatol 5:845–851, 1993
Jalan R, Hayes PC: Review article: Quantitative tests of liver function. Aliment Pharmacol Ther 9:263–270, 1995
Testa R, Campo N, Caglieris S, Risso D, Alvarez S, Arzani L, Giannini E, Lantieri PB, Celle G: Lidocaine elimination and monoethylglycinexylidide formation in patients with chronic hepatitis or cirrhosis. Hepato-Gastroenterology 45:154–159, 1998
Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan TW, Wollman J: Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1:431–435, 1981
Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–664, 1973
Siegel S, Castellan NJ Jr: Nonparametric Statistics for the Behavioral Sciences. New York, McGraw-Hill, 1988
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Giannini, E., Botta, F., Fasoli, A. et al. Progressive Liver Functional Impairment Is Associated with an Increase in AST/ALT Ratio. Dig Dis Sci 44, 1249–1253 (1999). https://doi.org/10.1023/A:1026609231094
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DOI: https://doi.org/10.1023/A:1026609231094