From the Guidelines
Elevated GGT levels in cirrhosis are common and not necessarily normal, as they can indicate liver cell damage and cholestasis. In the context of cirrhosis, GGT is often elevated due to the liver's reduced ability to process and eliminate substances, leading to accumulation 1. According to the EASL clinical practice guidelines, GGT is an indirect marker for alcohol consumption, but its specificity is lost in more advanced liver disease, such as cirrhosis, where its activity is elevated regardless of the cause 1.
Key Points to Consider
- GGT elevation in cirrhosis can be caused by liver cell damage, cholestasis, and oxidative stress
- Normal GGT values range from 8-61 U/L for men and 5-36 U/L for women, but in cirrhosis, levels can be significantly higher
- GGT elevation is not specific to cirrhosis alone and can be caused by alcohol consumption, certain medications, and other liver or biliary tract diseases
- Management typically focuses on treating the underlying cause of cirrhosis rather than specifically targeting GGT levels 1
Clinical Implications
- Monitoring GGT can help assess liver function and disease progression in cirrhosis patients
- However, GGT should be interpreted in the context of other laboratory values and clinical findings, as its elevation is not specific to cirrhosis 1
- The AST/ALT ratio, which is typically greater than 1 in cirrhosis, is neither specific nor sensitive, particularly in the cirrhotic stage of disease 1
From the Research
GGT Elevated in Cirrhosis
- GGT (gamma-glutamyltransferase) is an enzyme that can be elevated in various liver conditions, including cirrhosis 2.
- In cirrhotic patients, the s-GGT fraction is significantly increased, while the b-GGT/s-GGT ratio is decreased 2.
- The b-GGT/s-GGT ratio has been shown to be a sensitive biomarker of liver parenchymal rearrangement, even in patients with total GGT values within the reference range 2.
- Elevated GGT levels can be associated with more advanced liver disease in chronic hepatitis C 3.
Normal GGT Levels in Cirrhosis
- It is possible for cirrhotic patients to have normal GGT levels, as the b-GGT/s-GGT ratio can still be decreased even with normal total GGT values 2.
- The diagnostic accuracy of the b-GGT/s-GGT ratio is maintained in cirrhotic patients with total GGT values within the reference range 2.
- Other liver enzymes, such as ALT and AST, can also be elevated in cirrhosis, and their levels can guide the evaluation of liver disease 4.
Clinical Significance of GGT Elevation
- Elevated GGT levels can be associated with increased liver-related mortality and are an independent predictor of risk for coronary heart disease, Type 2 diabetes, and stroke 5.
- GGT elevation can also be a marker of drug-induced liver injury, even in the absence of conventional diagnostic criteria 6.
- The clinical significance of GGT elevation should be interpreted in the context of other liver enzymes and clinical features, such as liver biopsy and imaging results 4.