What are the results of the Aspartate Aminotransferase (AST or SGOT) and Alanine Aminotransferase (ALT or SGPT) exams?

From the Guidelines

Elevated levels of Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) may indicate liver damage from conditions like hepatitis, alcohol abuse, medication toxicity, or liver disease, and the ratio between these enzymes can help diagnose specific conditions, such as an AST:ALT ratio greater than 2:1 suggesting alcoholic liver disease 1. The results of the AST and ALT exams are typically interpreted together as part of a liver function panel, with normal AST levels ranging from 5-40 units/L and normal ALT levels ranging from 7-56 units/L, though reference ranges may vary by laboratory 1. Some key points to consider when interpreting the results of these exams include:

• The severity of abnormal aminotransferase can be classified as mild, moderate, or severe, with moderate and severe elevations indicating significant liver damage 1
• The ratio between AST and ALT can help diagnose specific conditions, such as an AST:ALT ratio greater than 2:1 suggesting alcoholic liver disease 1
• Elevated levels of AST and ALT can also be caused by non-hepatic conditions, such as hemolysis, myopathy, thyroid disease, or exercise 1
• The interpretation of abnormal liver chemistries must be taken in the clinical context of a given patient, including their medical history, medications, and physical examination findings 1 It is essential to note that the evaluation of patients with AST and ALT elevations should be directed toward establishing a specific diagnosis, rather than following an algorithm, and that the algorithm approach is useful mainly when there are no clinical clues or when the suspected diagnosis cannot be verified 1. In clinical practice, the results of the AST and ALT exams should always be interpreted by a healthcare provider in the context of the patient's overall health, including their medical history, physical examination findings, and other diagnostic test results 1.

From the FDA Drug Label

In pre-approval clinical studies worldwide, over 4500 subjects were treated with ACTOS. In U.S. clinical studies, over 4700 patients with type 2 diabetes received ACTOS. There was no evidence of drug-induced hepatotoxicity or elevation of ALT levels in the clinical studies. During pre-approval placebo-controlled clinical trials in the U.S., a total of 4 of 1526 (0. 26%) patients treated with ACTOS and 2 of 793 (0. 25%) placebo-treated patients had ALT values ≥ 3 times the upper limit of normal.

Serum ALT (alanine aminotransferase) levels should be evaluated prior to the initiation of therapy with ACTOS in all patients and periodically thereafter per the clinical judgment of the health care professional.

During all clinical studies in the U. S., 14 of 4780 (0.30%) patients treated with ACTOS had ALT values ≥ 3 times the upper limit of normal during treatment. All patients with follow-up values had reversible elevations in ALT.

The results of the Aspartate Aminotransferase (AST or SGOT) and Alanine Aminotransferase (ALT or SGPT) exams are as follows:

• ALT levels: 4 of 1526 (0.26%) patients treated with ACTOS had ALT values ≥ 3 times the upper limit of normal.
• AST levels: Not explicitly reported in the provided text, but it is mentioned that liver function tests, including AST, should be evaluated. It is recommended that patients treated with ACTOS undergo periodic monitoring of liver enzymes, including ALT and AST levels, prior to the initiation of therapy and periodically thereafter 2.

From the Research

Results of AST and ALT Exams

The results of the Aspartate Aminotransferase (AST or SGOT) and Alanine Aminotransferase (ALT or SGPT) exams can be used to diagnose and monitor liver disease.

• The SGOT/SGPT ratio is significantly elevated in patients with alcoholic hepatitis and cirrhosis, with a ratio greater than 2 being highly suggestive of these conditions 3.
• Elevated ALT levels are widely used to screen for liver disease, and even small amounts of alcohol intake may be harmful in individuals with elevated ALT levels 4.
• The interpretation of ALT and AST plasma levels can be complicated, and new biomarkers of liver injury are being developed to complement or replace these tests 5.
• Low-cost point-of-care monitoring of ALT and AST is promising for faster decision making and diagnosis of acute liver injury, particularly in developing countries 6.
• Liver function tests, including SGOT, can be abnormal in adults receiving total parenteral nutrition, with a "meaningful" increase in SGOT levels noted in 68% of patients 7.

Key Findings

• An SGOT/SGPT ratio greater than 2 is highly suggestive of alcoholic hepatitis and cirrhosis 3.
• Small amounts of alcohol intake are associated with increased liver-related and all-cause mortality among individuals with elevated ALT levels 4.
• ALT and AST levels are crucial for diagnosing and assessing liver diseases, but their interpretation can be complicated 5.
• Low-cost biosensing methods, such as paper-based assays, can be used to semi-quantitatively measure ALT and AST levels in biological fluids 6.
• Elevated liver function values, including SGOT, can occur in adults receiving total parenteral nutrition, with possible causes including cellular damage and an "overshoot" of enzymes 7.