What is the significance of low globulin, high albumin, and elevated alanine transaminase (ALT) levels?

From the Guidelines

Patients with low globulin, high albumin, and elevated alanine transaminase (ALT) levels should be promptly evaluated for liver dysfunction, as this combination may indicate liver inflammation or damage, and treatment should be guided by the underlying cause, as recommended by recent guidelines on liver blood tests 1. The clinical significance of these abnormal lab values lies in their potential to indicate liver damage or inflammation, which can be caused by various conditions such as viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, or medication-induced liver injury. Key points to consider in the interpretation of these lab results include:

• Elevated ALT levels, even within the normal range, may be significant in certain populations, such as those with chronic hepatitis B, where treatment guidelines recommend an ALT of >30 U/L as being significant in males and >19 U/L significant for females 1.
• The presence of low globulin and high albumin levels may suggest altered protein production, which can be a sign of liver dysfunction.
• Additional tests, such as a complete liver panel, viral hepatitis screening, and imaging studies like an ultrasound or CT scan, may be necessary to determine the underlying cause of these abnormal lab values. While waiting for a medical evaluation, it is essential to:
• Avoid alcohol completely
• Discontinue any non-essential medications or supplements after consulting a doctor
• Maintain a healthy diet low in processed foods and sugar
• Stay well-hydrated It is crucial to note that the current upper limit of normal for many liver enzymes, including ALT, may be too high, which can lead to delayed diagnosis and treatment of liver disease 1. Therefore, a thorough clinical assessment and interpretation of lab results are critical in determining the appropriate course of action for patients with abnormal liver blood tests.

From the Research

Significance of Low Globulin, High Albumin, and Elevated ALT Levels

• Low globulin levels can be associated with liver disease, as the liver is responsible for producing globulins 2.
• High albumin levels are often seen in patients with liver cirrhosis, where there is an increase in serum albumin after treatment with ursodeoxycholic acid (UDCA) 3.
• Elevated alanine transaminase (ALT) levels are a common indicator of liver damage or disease, and can be reduced with treatment such as UDCA [(4, 3, 5)].

Liver Function Tests

• Liver function tests, including ALT, are critical in recognizing the presence of liver disease and its specific diagnosis 2.
• The interpretation of liver function tests can be confusing and difficult, and not all persons with test abnormalities actually have liver disease 2.
• Commonly available tests like serum bilirubin, liver enzymes (ALT and AST), serum alkaline phosphatase (ALP), and serum albumin can partly assess liver functions 6.

Treatment and Management

• Ursodeoxycholic acid (UDCA) has been shown to be effective in treating patients with chronic hepatitis, with improvements in ALT and AST levels [(4, 3, 5)].
• The efficacy of UDCA in lowering serum AST and ALT is more pronounced in the presence of cirrhosis 5.
• Combinations of blood parameters, such as the fibrosis score of 4 (FIB-4) and the model for end-stage liver disease (MELD) score, are commonly used to assess liver function in clinical practice 6.