AST (SGOT) and ALT (SGPT) are sensitive indicators of liver damage or injury from different types of disease. But it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not. For example, elevations of these enzymes can occur with muscle damage. The interpretation of elevated AST and ALT levels depends upon the entire clinical evaluation of a patient, and so it is best done by doctors experienced in evaluating liver disease.
The precise levels of these enzymes do not correlate well with the extent of liver damage or the prognosis (outlook). Thus, the exact levels of AST (SGOT) and ALT (SGPT) cannot be used to determine the degree of liver disease or predict the future. For example, patients with acute viral hepatitis A may develop very high AST and ALT levels (sometimes in the thousands of units/liter range). But most patients with acute viral hepatitis A recover fully without residual liver disease. For a contrasting example, patients with chronic hepatitis C infection typically have only a little elevation in their AST and ALT levels. Some of these patients may have quietly developed chronic liver disease such as chronic hepatitis and cirrhosis (advanced scarring of the liver).
It is, therefore, worth mentioning that these liver enzymes do not give an indication of the function of the liver. Sometimes they are mistakenly referred to as “liver function tests” or LFTs, but it is a misnomer commonly used.
In this Article
Introduction to liver blood test
What are the aminotransferases?
Normally, where are the aminotransferases?
What are normal levels of AST and ALT?
What do elevated AST and ALT mean?
What liver diseases cause abnormal aminotransferase levels?
What medications cause abnormal aminotransferase levels?
What are less common causes of abnormal aminotransferase levels?
How are healthy people evaluated for mild to moderate rises in aminotransferase levels?
How about monitoring aminotransferase levels?
What about other liver enzymes?
Patient Discussions: Liver Blood Tests - Helped With Your Diagnosis
Liver Blood Tests Index
What liver diseases cause abnormal aminotransferase levels?
The highest levels of AST and ALT are found with disorders that cause the death of numerous liver cells (extensive hepatic necrosis). This occurs in such conditions as:
acute viral hepatitis A or B,
pronounced liver damage inflicted by toxins as from an overdose of acetaminophen (brand-name Tylenol), and
prolonged collapse of the circulatory system (shock) when the liver is deprived of fresh blood bringing oxygen and nutrients.
AST and ALT serum levels in these situations can range anywhere from ten times the upper limits of normal to thousands of units/liter.
Mild to moderate elevations of the liver enzymes are commonplace. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT levels in such cases are usually between twice the upper limits of normal and several hundred units/liter.
One of the most common cause of mild to moderate elevations of these liver enzymes is fatty liver. In the United States, the most frequent cause of fatty liver is alcohol abuse. Other causes of fatty liver include diabetes mellitus and obesity. Chronic hepatitis C is also becoming an important cause of mild to moderate liver enzyme elevations.
Absolutely the disease is called nash when it progresses from fatty liver to larger fat deposits in the liver called steatosis. the only treatment is to be at your correct weight, excercise and eat foods low in carbs and fat.
My GUESS is that after many years of the virus attacking your liver it finally starts to poop out. A liver enzyme is released when a liver cell dies - after the virus is beating down the door for so many years it is logical that the liver would just be torn down and the cells would start dying off more easily.
This is all complete speculation on my part - I just always figured that the older we get so to speak the more cells were dying off because face it....we aren't young any longer and after 30 years of it trying to do its job...chances are it gets a bit easier.
I wouldn't rule out the possibility that many people never had labs drawn or, if they did, they didn't pay attention to or perhaps even see the results. Maybe there were elevations that if we had known what we know today would have alerted us to a possible problem. A lot of people only learn they have a problem when they apply for life insurance or donate blood. I never had blood test when I was in my twenties, thirties and early forties. If I had I would have likely have seen some signs of trouble.
I've been monitoring my labs on and off for 20+ years, since I was a heavy binge drinker in my late teens/20's/30's, so oddly, I was concerned about my liver health, or rather, how long it could hold up under the strain I guess. Ahh, the follies of youth.
I've never had elevated enzymes, until 2 years ago. My AST was 2 points over normal on a routine physical. My PCP wasn't concerned, but he did want to recheck it in a month or so he said. Next month it was normal. Anyhow, to make a long story short, they danced around a bit over the last two years, never more than a few points above normal.
Then in January, all of a sudden they are 10 points over (both AST and ALT) and have been stable since.
Wish I knew definitively why they changed. I'm inclined to agree with some others in that as we age, gradually the immune system doesn't quite keep up as well as it used to. The virus gets a little bit of an edge.
Got to be something different. Something has changed.
In order to find out the cause of elevated liver enzymes Robert, I would start by thinking back a little. Why do they elevate? They could elevate due to alcohol, unhealthy eating habits, or medications that cause liver damage that elevate liver enzymes. It's important to maintain healthy habits in order to prevent any further increase in liver enzymes.
There is a wide range of various degrees in terms of serum enzymes.
At one end of the spectrum, infected persons may have no signs or symptoms of disease progression and could have normal levels of serum enzymes, the usual blood test results that indicates a further progressed stage.
At the other end of the spectrum are patients with severe hepatitis C who have symptoms, high levels of the virus (HCV RNA) in serum, and elevated serum enzymes, and who ultimately develop cirrhosis and end-stage liver disease.
In the middle of the spectrum are many patients who have few or no symptoms, mild to moderate elevations in liver enzymes, and an uncertain prognosis.
A few points isn't something I'd be too worried about, hope you get it back to normal soon. Cory.
Thanks Cory, I've racked my brain trying to figure out if there is anything different in my environment - what I eat, how I treat myself, etc. If anything, the last year or so I have been taking even BETTER care of myself than before. Regular exercise, good diet, plenty of rest, etc. I can't remember the last time I was sick or felt bad.
Now that I think back though, my enzymes have always been in like the top 15% of the normal range. Perhaps that's just where the Hep C kept them for so many years. It'll be interesting to see when I begin to treat if the AST/ALT number drop to very low levels.
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