From the Guidelines
High liver enzyme readings are concerning for cirrhosis, particularly when associated with other signs of liver damage and impaired liver function, such as decreased albumin levels and elevated bilirubin. In patients with elevated liver enzymes, it is essential to evaluate for the presence of nonalcoholic steatohepatitis and liver fibrosis, as recommended by the standards of medical care in diabetes-2021 1. High liver enzyme readings in cirrhosis typically show elevated AST (aspartate aminotransferase) and ALT (alanine aminotransferase), often with AST higher than ALT. Some key points to consider when evaluating high liver enzyme readings include:
- Elevated AST and ALT levels, with AST often higher than ALT
- Decreased albumin levels (below 3.5 g/dL) and elevated bilirubin (above 1.2 mg/dL)
- Elevated alkaline phosphatase, gamma-glutamyl transferase (GGT), prolonged prothrombin time, and decreased platelet count (below 150,000/μL)
- The severity of enzyme elevation does not always correlate with disease severity, as enzymes may actually decrease in end-stage cirrhosis when few functioning liver cells remain
- Regular monitoring of these values is essential for patients with known liver disease, and any persistent elevation warrants further investigation with imaging studies and possibly liver biopsy, as suggested by the EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease 1. Lifestyle modifications, including alcohol cessation, weight management, and avoiding hepatotoxic medications, are crucial for anyone with abnormal liver enzymes. It is also important to screen for features of metabolic syndrome, such as waist circumference, arterial pressure, fasting glucose, serum triacylglycerols, and HDL cholesterol, as these are associated with an increased risk of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis 1.
From the Research
High Liver Enzyme Readings and Cirrhosis
High liver enzyme readings can be concerning for cirrhosis, as they may indicate liver damage or disease. Some key points to consider include:
- Elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate transaminase (AST), can be a sign of liver damage or disease 2
- Ursodeoxycholic acid (UDCA) has been shown to improve liver enzyme levels and have a beneficial effect on liver health in patients with nonalcoholic fatty liver disease (NAFLD) 3, 2
- UDCA has also been used to treat other liver diseases, including primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis 4, 5, 6
- While UDCA may improve liver enzyme levels, its effect on disease progression and survival in non-cholestatic liver diseases is not yet fully established 5, 6
Liver Enzyme Readings and Disease Progression
Some studies have investigated the relationship between liver enzyme readings and disease progression, including:
- A study found that UDCA treatment resulted in a significant decrease in ALT levels in patients with NAFLD, with the greatest decrease occurring in the first 3 months of treatment 2
- Another study found that UDCA improved liver biochemistry in patients with autoimmune hepatitis and hepatitis B and C infections, but the effect on histologic disease was inconsistent 5
- A review of the literature found that UDCA may delay the development of gastroesophageal varices and progression to cirrhosis in patients with primary biliary cirrhosis, but the long-term effects of UDCA in other liver diseases are not yet established 6
Treatment and Management
Treatment and management of high liver enzyme readings and cirrhosis may involve:
- Lifestyle modifications, such as weight loss and diet changes, to improve liver health 2
- Medications, such as UDCA, to improve liver enzyme levels and reduce liver damage 4, 3, 2, 5, 6
- Monitoring of liver enzyme levels and other markers of liver health to track disease progression and response to treatment 2, 5