alt ast ratio

My alt is 14 and ast is 28.  The ratio is 2.0
Is this 2.0 ratio something to be concerned about?

[Bob368]

No, the normal ranges for AST and ALT are 2 to 45 and 2 to 40, respectively. You are well in the normal range. The ratio is not a related factor until the AST and/or ALT become abnormally high. Don't worry.

Bob :)

[craigchome]

Not to disagree with bob368, but from what I understand most liver diseases  are characterized by greater ALT elevations than AST elevations.  Two exceptions to this rule exist.  Both cirrhosis and/or alcohol abuse are associated with higher AST levels  than ALT levels, often in a ratio of approximately 2:1.

From the data you supplied I would suggest that you should be very concerned.

[mikesimon]

I agree with Bob when he said: "The ratio is not a related factor until the AST and/or ALT become abnormally high."
Whatever diagnostic value the AST/ALT ratio has it is not applicable in a patient whose values are normal. I have labs in which my ALT was 11 and my AST was 20 and another where my ALT was 14 and my AST was 30. I also know that alcohol was not a factor and I was not cirrhotic. I know that from liver tissue biopsy.
My understanding is the ratio has some value when there is a significant elevation of liver enzymes but not when the enzymes are well within normal.
Mike

[craigchome]

I'm afraid I still disagree....I quote:

Alcoholic liver disease
Alcoholic liver disease, one of the most common causes of chronic liver disease in the US population, should be suspected in any patient who consumes more than 70 to 80 g/d of alcohol (about 5 drinks). Women are at risk at lower consumption rates (about 2 drinks a day). The diagnosis of alcoholic liver disease is supported by the finding of an AST to ALT ratio of at least 2:1. The degree of aminotransferase elevation may also be helpful in identifying alcohol abuse. It is rare for the AST level to be more than 8 times the normal value in patients with alcohol abuse, and it is even less common for the ALT level to be more than 5 times the normal value in such patients. In fact, the ALT level may be normal, even in patients with severe alcoholic liver disease. - End Quote

Note: "the ALT level may be normal, even in patients with severe alcoholic liver disease"

Quote taken from:

http://en.allexperts.com/q/Family-Internal-Medicine-969/muscle-enzyme-1.htm

So returning to the original question, is the 2:0 ratio something to be worried about? - Yes, a 2:0 ratio doesn't exist!

Is a 2:1 ratio something to be worried about? - Yes it is even if the ALT level is normal. What is 'abnormal' is the 2:1 ratio and it is the ratio that is indicative of alcoholic liver disease irrespective of values.

Craig

[mikesimon]

Is it possible? Yes, it is. Cirrhotic patients can get to the point where they lack sufficient live liver tissue to release enzymes. I don't think that's the case here.
AST 28 AST 14 - Do I find those numbers alarming? No.
If I saw an elevated GGT or a slow clotting time I might be concerned about a possible  liver issue. But, when ALT and AST are both within normal I don't think an AST/ALT ratio of 2 is, in itself, very worrisome.
Uncle Bill didn't even mention alcohol consumption.
Mike

[craigchome]

Therefore not enough information was supplied in the first place. As uncle bill was concerned enough to post in the first place perhaps the safest suggestion is for him to consult with his doctor as there is a possibility of liver disease?

Craig

[mikesimon]

If Uncle Bill is worried then, I agree with you. He should see a specialist and get some answers. I never discourage a patient from seeking professional advice.
Mike