Progressive liver functional impairment is associated with an increase in AST ALT ratio

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 e xistence of a relationship between the ratio and liver functional impairmen t. In all, 348 patients (177 with chronic hepatitis, 171 with cirrhosis) we re 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 w ith mild fibrosis from those with severe fibrosis and cirrhosis. The AST/AL T ratio, MEGX, prothrombin activity, and platelet count were selected by mu ltivariate analysis as variables associated with cirrhosis. The AST/ALT rat io showed significant correlations both with MEGX formation and with indocy anine green clearance and half-life. The alterations of indocyanine green k inetics, which depend upon liver blood flow and uptake, were likely due to progressive fibrosis. These findings might partially explain the increase i n the AST/ALT ratio as disease progresses.