What does elevated Alanine Transaminase (ALT) and Aspartate Transaminase (AST) indicate?

From the Guidelines

ALT of 58 U/L and AST of 62 U/L indicate mildly elevated liver enzymes, suggesting possible liver inflammation or injury, and warrant further investigation. These values are typically above the normal range, with normal ALT levels being 29 to 33 IU/L in men and 19 to 25 IU/L in women, as stated in the study by 1. The severity of abnormal aminotransferase can be classified as mild, moderate, or severe, with these values falling into the mild category, being less than 5 times the upper reference limit. Common causes of mildly elevated liver enzymes include medications, alcohol consumption, viral hepatitis, fatty liver disease, or other liver conditions, as discussed in the study by 1.

The ratio of AST to ALT, which is close to 1:1 in this case, can provide diagnostic clues, with ratios greater than 2:1 often suggesting alcohol-related liver disease, while lower ratios are more common in other conditions, such as nonalcoholic fatty liver disease (NAFLD) or metabolic disease-related fatty liver, as mentioned in the study by 1. It is essential to follow up with a healthcare provider for evaluation, which may include additional blood tests, imaging studies, or lifestyle modifications, and to avoid alcohol and review medications with the doctor, as these enzymes are released when liver cells are damaged, serving as markers of liver health.

Given the information provided, the most recent and highest quality study, 1, suggests that NAFLD is the most common liver disease in first-world countries, with a prevalence of 20% to 30% in the general population, and that the AST:ALT ratio is generally >2 in alcohol-induced fatty liver disease and <1 in metabolic disease-related fatty liver. Therefore, it is crucial to investigate further to determine the underlying cause of the elevated liver enzymes and to develop an appropriate treatment plan.

From the Research

Interpretation of ALT and AST Levels

• ALT (Alanine Aminotransferase) and AST (Aspartate Aminotransferase) are biomarkers used to assess liver damage 2.
• An ALT level of 58 U/L and an AST level of 62 U/L indicate elevated liver enzymes, which may suggest liver damage or disease.

Possible Causes of Elevated ALT and AST

• Common causes of elevated ALT and AST include:
  • Chronic alcohol consumption
  • Non-alcoholic steatohepatitis (NASH)
  • Chronic viral hepatitis
  • Metabolic dysfunction-associated steatotic liver disease (MASLD)
  • Alcoholic liver disease 3, 4
• Less common causes include:
  • Drug-induced liver injury
  • Chronic hepatitis B and C
  • Hereditary hemochromatosis
  • Alpha1-antitrypsin deficiency
  • Autoimmune hepatitis
  • Wilson disease 4, 5
• Extrahepatic causes, such as:
  • Polymyositis
  • Acute muscle injury
  • Acute myocardial infarction
  • Hypothyroidism
  • Celiac disease
  • Hyperthyroidism
  • Rhabdomyolysis
  • Pregnancy-associated liver disease 3, 2, 4, 5

Evaluation and Next Steps

• Initial laboratory testing should include a complete blood cell count, blood glucose, lipid profile, hepatitis B surface antigen, hepatitis C antibody, serum albumin, iron, total iron-binding capacity, and ferritin 4, 5.
• If MASLD is suspected, the FIB-4 Index Score or NAFLD Fibrosis Score can be used to predict which patients are at risk for fibrosis and may benefit from further testing or referral to a hepatologist 4.
• Patients with elevated transaminases should be counseled about moderation or cessation of alcohol use, weight loss, and avoidance of hepatotoxic drugs 4.