AST/ALT Ratio – What Does It Mean in Your Lab Results?

The AST/ALT ratio, also known as the De Ritis ratio, is a calculated value from two liver enzymes: aspartate aminotransferase (AST) and alanine aminotransferase (ALT). These enzymes are found primarily in the liver and play a key role in amino acid metabolism. The ratio helps doctors assess liver health and identify potential liver diseases or other underlying conditions.

What Is the AST/ALT Ratio?

The ratio is simply the result of dividing your AST level by your ALT level.

  • Normal AST/ALT ratio: Typically around 0.7–1.2.
  • A ratio > 1 can indicate chronic liver disease, such as alcoholic liver disease, cirrhosis, or advanced fibrosis.
  • A ratio < 1 is commonly seen in acute liver injury or non-alcoholic fatty liver disease (NAFLD).

Why Is the AST/ALT Ratio Important?

The AST/ALT ratio is used in conjunction with other liver function tests to determine the cause of liver abnormalities. It can provide clues about specific liver conditions:

  1. Alcoholic Liver Disease

    • A ratio greater than 2 is highly suggestive of alcoholic liver disease, especially if accompanied by elevated GGT levels.
  2. Non-Alcoholic Fatty Liver Disease (NAFLD)

    • Typically shows a ratio less than 1.
  3. Viral Hepatitis or Acute Liver Injury

    • The ratio is usually less than 1, with ALT being significantly higher than AST.
  4. Cirrhosis

    • In cirrhosis, particularly from causes other than alcohol, the ratio may be around 1–1.5.
  5. Muscle Injury or Myopathy

    • Since AST is also present in muscles, a high AST/ALT ratio might be seen in muscle-related conditions.

How to Interpret the AST/ALT Ratio in Your Lab Results

  • AST and ALT both elevated with a high ratio (> 2) → Think alcohol-related damage.
  • Both enzymes elevated but ratio < 1 → Often related to viral hepatitis or non-alcoholic fatty liver disease.
  • Normal ratio but elevated levels → May indicate acute liver injury, requiring further investigation.

Conclusion

The AST/ALT ratio is a helpful biomarker for identifying the cause of abnormal liver enzyme levels. However, it should always be interpreted in the context of other tests and clinical symptoms. If your AST/ALT ratio is abnormal, discuss it with your healthcare provider to understand its implications for your liver health and overall well-being.

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