High aspartate to alanine aminotransferase ratio is an indicator of cirrhosis and poor outcome in patients with primary sclerosing cholangitis.
OBJECTIVE
A liver biopsy is performed mainly to stage primary sclerosing cholangitis (PSC). In viral hepatitis, alcoholic liver disease and in primary biliary cirrhosis, the ratio of aspartate to alanine aminotransferase (AST/ALT) has been proven to be an indicator of liver cirrhosis. We wanted to test whether or not an AST/ALT ratio >/=1 is an indicator of cirrhosis also in patients with PSC.


METHODS
A cohort of 154 patients diagnosed with PSC was studied retrospectively. Laboratory tests and the histological stage were scored.


RESULTS
The mean AST/ALT ratio in the cirrhotic patients at the time of the first (n=117) as well as the last (n=72) histological examination was higher (1.3+/-0.5 and 1.6+/-0.7, respectively) than in the non-cirrhotic patients (0.7+/-0.4 and 1.0 +/-0.4, respectively) (P<0.0001 and P=0.0002, respectively). An AST/ALT ratio >/=1 was a strong predictor for liver-related death/orthotopic liver transplantation and liver-related death, being associated with a double and an almost fourfold higher risk, respectively.


CONCLUSIONS
An AST/ALT ratio >/=1 is significantly associated with the presence of cirrhosis and poor outcome in PSC. It may therefore be a valuable non-invasive method for indicating cirrhosis in patients with PSC.
Nyblom
Helena
H
Department of Internal Medicine, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
Nordlinder
Hans
H
Olsson
Rolf
R
D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism*; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis / Q000201:enzymology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000201:enzymology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase