Let's agree to disagree on this one. On some points I even think we agree. This is how I understand it. Remember I am only a layman.
If your AST/ALT ratio is less than 1 (ie your ALT is higher than your AST) and you have elevated liver enzymes, that indicates non-alcoholic liver disease, for example hepatitis C. (Realize that even with liver enzymes within normal range, they may be elevated for a hep C patient compared to his/her healthy liver enzyme readings before contracting hep C.) You will most likely see greater ALT elevations than AST elevations for the hep C patient without cirrhosis.
In chronic liver disease, for example hepatitis C, ALT is likely to be greater than AST.
In chronic liver disease, once cirrhosis is established, AST is likely to be greater than ALT.
An AST/ALT ratio greater than 2 in a patient without viral hepatitis indicates alcohol induced liver disease. The higher the ratio the greater probability that the cause is alcohol induced liver disease.
Once SVR, the AST/ALT ratio in the non-cirrhotic patient is most likely to be greater than 1 (ie AST is higher than ALT) but less than 2. But as long as one is UND, this really does not matter. I was just curious if this theory held true in RJGCedar's case.
I remember reading the study you posted to back up your statements last time this was up for discussion. I could not see anything in it that was contradictive to my thoughts. Maybe we are just talking past each other. I will see if I can find it again and get back to you.
The poster was SVR.
You said to the poster, " bet your ALT is lower than your AST, right? Higher ALT than AST shows that you have an infection, for example hepatitis C, going on. And you don't any more!"
This is simply incorrect for reasons stated and nothing to "agree to disagree on". I believe Dieterich answered the same question in the Expert Forum, but if not, just ask your doctor the signficance of the AST/ALT ratio in SVRs with normal enzymes. But again, the ALT/AST ratio is irrelevant in SVRs with normal liver enzymes. It's nada, nilche, nunca :) I know what my liver specialist would say because I asked him point blank when my SVRd ALT was a bit higher than my SVRd AST.
What some believe the ratio is useful for is as an indication of liver damage (fibrosis) in those with HCV and elevated liver enzymes. That said, only a liver biopsy can be fully relied on.
Found this to back up my statements:
"The ratio of AST to ALT has some clinical utility, but has important limitations. In many forms of acute and chronic liver injury or steatosis (fatty infiltration of the liver), the ratio is less than or equal to 1. This is particularly true in patients with hepatitis C. However, an AST/ALT ratio greater than 2 characteristically is present in alcoholic hepatitis. ... While these ratios are suggestive of certain conditions, there is too much overlap between groups to rely on them exclusively when making a diagnosis."
Excerpt from table 3 "Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels":
"CLINICAL CLUE --- SUGGESTED DIAGNOSIS
Longstanding alcohol abuse --- Cirrhosis
Intravenous drug use, history of blood product transfusions, nonsterile needle exposure, AST/ALT ratio < 1.0 --- Hepatitis B or C
Obesity, diabetes, hyperlipidemia, AST/ALT ratio 2.0 --- Alcoholic liver disease, Wilson's disease"
The reason I find the AST/ALT ratio interesting is because I am curious to if it can help us unfortunate souls who have to wait for a PCR post tx, but do have the opportunity to get liver enzyme readings, to in some way get an indication of relapse or SVR. By asking someone who is SVR, I am trying to find out if in his case what was true for me, was true for him, i e as a hep C patient my AST was always lower than my ALT prior to tx but after tx my AST was higher than my ALT.
Considering the clinical clues I posted above, I would be happy if you would stop saying I am incorrect when you are discussing fibrosis and I am discussing clinical clues to diagnosis. We are not even discussing the same thing.
Zazza: Considering the clinical clues I posted above, I would be happy if you would stop saying I am incorrect when you are discussing fibrosis and I am discussing clinical clues to diagnosis. We are not even discussing the same thing.
Yes we are. I'm saying you are incorrect when discussing "clinical clues" per what the original poster stated. But for the last time, you cannot draw any assumptions from the alt/ast ratio in an SVR patient with normal liver enzymes. I only mentioned "fibrosis" because some believe you can draw assumptions there. Hopefully, anyone interested in the subject will carefully re-read both the original post, your response(s), my response(s), and come to their own conclusions. They might also ask their doctor should they have a good liver specialist.
Jm: I only mentioned "fibrosis" because some believe you can draw assumptions there.
Reference was to the non SVR patient with elevated enzymes.