title: Progressive liver functional impairment is associated with an increase in AST/ALT ratio.
abstract: The ratio of serum aspartate aminotransferase to alanine aminotransferase (AST/ALT ratio) has been proposed as a noninvasive method of assessing liver fibrosis and cirrhosis. Our aims were to confirm the usefulness of the AST/ALT ratio in diagnosing cirrhosis noninvasively as well as to verify the existence of a relationship between the ratio and liver functional impairment. In all, 348 patients (177 with chronic hepatitis, 171 with cirrhosis) were retrospectively evaluated and the AST/ALT ratio was related to monoethyl glycine xylidide (MEGX) formation. Moreover, in a subgroup of 54 patients we analyzed the relationships among the AST/ALT ratio and indocyanine green clearance and half-life. The AST/ALT ratio was able to separate patients with mild fibrosis from those with severe fibrosis and cirrhosis. The AST/ALT ratio, MEGX, prothrombin activity, and platelet count were selected by multivariate analysis as variables associated with cirrhosis. The AST/ALT ratio showed significant correlations both with MEGX formation and with indocyanine green clearance and half-life. The alterations of indocyanine green kinetics, which depend upon liver blood flow and uptake, were likely due to progressive fibrosis. These findings might partially explain the increase in the AST/ALT ratio as disease progresses.
authors.affiliation: Gastroenterology Unit, Department of Internal Medicine (D.I.M.I), University of Genova, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Giannini
authors.forename: F
authors.initials: F
authors.lastname: Botta
authors.forename: A
authors.initials: A
authors.lastname: Fasoli
authors.forename: P
authors.initials: P
authors.lastname: Ceppa
authors.forename: D
authors.initials: D
authors.lastname: Risso
authors.forename: P B
authors.initials: PB
authors.lastname: Lantieri
authors.forename: G
authors.initials: G
authors.lastname: Celle
authors.forename: R
authors.initials: R
authors.lastname: Testa
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002908:Chronic Disease; D004796:Clinical Enzyme Tests / Q000379:methods / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000145:classification / Q000175:diagnosis; D019698:Hepatitis C, Chronic / Q000097:blood / Q000145:classification / Q000175:diagnosis; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000145:classification / Q000175:diagnosis; D008111:Liver Function Tests / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D008012:Lidocaine; C001173:monoethylglycinexylidide; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase