From the Guidelines
An elevated ALT of 73 on its own with otherwise normal labs typically indicates mild liver inflammation or injury, and the most appropriate next step is to repeat the test in 4-6 weeks to see if the elevation persists, as recommended by the most recent guidelines 1. This finding warrants follow-up but isn't usually cause for immediate alarm. Common causes include:
- Medication effects (like statins, certain antibiotics, or over-the-counter pain relievers)
- Alcohol consumption
- Fatty liver disease
- Viral hepatitis
- Temporary elevation due to recent strenuous exercise In the meantime, it is advisable to:
- Limit alcohol consumption
- Review all medications (including supplements and herbal remedies) with your healthcare provider
- Maintain a healthy diet and exercise routine If symptoms like fatigue, abdominal pain, jaundice, or dark urine are experienced, seek medical attention sooner. ALT is an enzyme primarily found in liver cells, and when these cells are damaged, ALT leaks into the bloodstream, causing elevated levels. Mild elevations (typically less than 2-3 times the upper limit of normal) often resolve on their own but should still be monitored to ensure they don't represent an ongoing issue, as suggested by the American College of Radiology 1. The interpretation of abnormal liver chemistries must be taken in the clinical context of a given patient, considering their risk factors for liver disease, medications, alcohol consumption, comorbid conditions, and signs and symptoms of hepatic disease 1.
From the FDA Drug Label
Elevations in Liver Enzyme Tests Persistent elevations in serum transaminases, defined as more than 3 times the ULN and occurring on 2 or more occasions, occurred in 0. 7% of patients who received atorvastatin calcium in clinical trials.
An elevated ALT of 73 on its own with otherwise normal labs may indicate a potential issue with liver function, but it is not possible to draw a conclusion based on the provided information. The FDA label does not explicitly address the meaning of an isolated elevated ALT of 73. 2
From the Research
Elevated ALT Levels
An elevated ALT level of 73, with otherwise normal labs, can have various implications. Some possible causes include:
- Liver damage or disorders, as ALT is a specific marker for liver damage 3
- Non-alcoholic steatohepatitis (NASH) or non-alcoholic fatty liver disease (NAFLD), which can be associated with obesity and insulin resistance 4, 5
- Chronic viral hepatitis, although the elevation of liver enzyme may not correlate well with the degree of liver damage 6
- Non-hepatic causes such as polymyositis, acute muscle injury, acute myocardial infarction, or hypothyroidism 6
Interpretation of Elevated ALT
It is essential to note that an elevated ALT level does not necessarily predict worse effects to come or indicate the severity of liver injury or dysfunction 7. ALT is a useful biomarker for detecting liver injury, but it should be interpreted with caution and in the context of the individual's medical history and other laboratory results.
Further Evaluation
In the case of an asymptomatic person with elevated ALT and AST levels, the primary care doctor should obtain a complete history regarding risk factors for viral hepatitis, substance abuse, and request investigations accordingly 6. Suspected chronic viral hepatitis and liver cirrhosis are best referred to a hepatologist for further management.