Progressive liver functional impairment is associated with an increase in AST/ALT ratio

Edoardo Giannini, Federica Botta, Alberto Fasoli, Paola Ceppa, Domenico Risso, Pasquale Bruno Lantieri, Guido Celle, Roberto Testa

Research output: Contribution to journalArticlepeer-review


The ratio of serum aspartate aminotransferase to alanine aminotransferase (AST/ALT ratio) has been proposed as a noninvasive method of assessing liver fibrosis and cirrhosis. Our aims were to confirm the usefulness of the AST/ALT ratio in diagnosing cirrhosis noninvasively as well as to verify the existence of a relationship between the ratio and liver functional impairment. In all, 348 patients (177 with chronic hepatitis, 171 with cirrhosis) were retrospectively evaluated and the AST/ALT ratio was related to monoethyl glycine xylidide (MEGX) formation. Moreover, in a subgroup of 54 patients we analyzed the relationships among the AST/ALT ratio and indocyanine green clearance and half-life. The AST/ALT ratio was able to separate patients with mild fibrosis from those with severe fibrosis and cirrhosis. The AST/ALT ratio, MEGX, prothrombin activity, and platelet count were selected by multivariate analysis as variables associated with cirrhosis. The AST/ALT ratio showed significant correlations both with MEGX formation and with indocyanine green clearance and half-life. The alterations of indocyanine green kinetics; which depend upon liver blood flow and uptake, were likely due to progressive fibrosis. These findings might partially explain the increase in the AST/ALT ratio as disease progresses.

Original languageEnglish
Pages (from-to)1249-1253
Number of pages5
JournalDigestive Diseases and Sciences
Issue number6
Publication statusPublished - 1999


  • Alanine aminotransferase
  • Aspartate aminotransferase
  • Chronic hepatitis
  • Cirrhosis
  • Indocyanine green
  • Monoethyl glycine xylidide

ASJC Scopus subject areas

  • Gastroenterology


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