Evaluation of Liver Enzymes and calculation of AST to ALT ratio in patients with acute viral hepatitis
Abstract
Background: Acute viral hepatitis is a common liver-associated abnormality encountered in clinical practice. The number of biochemical parameters is estimated to detect a hepatic abnormality, which can measure the severity and types of damage to hepatocytes, among which liver enzymes and bilirubin levels are assessed routinely which are raised in acute viral hepatitis.
Objective: This study aims to assess the liver enzymes, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, and calculation of AST to ALT ratio in acute viral hepatitis and to compare these parameters with the control group.
Methodology: This study included a total of 81 subjects diagnosed with acute viral hepatitis as cases and age and sex-matched, the same number of healthy subjects as control. Serum levels of AST and ALT, alkaline phosphatase (ALP), and bilirubin were analyzed using standard methods. Serum AST to ALT ratio was calculated. Data analysis was done using SPSS Version 17.0 and the results were expressed as mean ±standard deviation (SD).
Results: A mean serum activities of aminotransferases were statistically significantly raised in viral hepatitis compared to that in control.AST (514.85±350.66 VS 25.65±5.29; p<0.001) and ALT (781.65±525.69 VS 27.94±6.50; p<0.001). Similarly, serum levels of(ALP)were significantly increased in acute viral hepatitis compared to that in control (202.17±75.46 VS 98.83±27.99; p<0.001. However, a ratio of AST to ALT was decreased significantly (0.66±0.15 VS 0.94±0.21; p= 0.001) in acute viral hepatitis compared to that in control.
Conclusion: Both the aminotransferases and bilirubin levels are raised significantly, where, a rise in ALT is greater than a rise in AST, hence, the ratio of AST to ALT is decreased significantly in acute viral hepatitis than that in control. Thus, this decreased pattern of AST to ALT can diagnose acute viral hepatitis at an early stage and can help appropriate care and treatment to the patients.
References
WHO, What is hepatitis?1 September 2019 | Q&A https://www.who.int/news-room/q-a-detail/what-is-hepatitis.
World Health Organization. 2017. Global Hepatitis Report 2017. Geneva. Available at: www.who.int/hepatitis/publications/global-hepatitis-report2017/en/ (accessed June 2018).
Gupta BP, Adhikari A, Chaudhary S. Hepatitis viruses in Kathmandu, Nepal: a hospital-based study. BMC Res Notes2018: 11, 627-31. https://doi.org/10.1186/s13104-018-3739-1
Limdi JK, Hyde GM. Evaluation of abnormal liver function tests. Postgrad Med J 2003;79:307–12. https://doi.org/10.1136/pmj.79.932.307
Al Jumaily EF, Khaleel FM. The effect of chronic liver diseases on some biochemical parameters in patient’s serum. Curr Res J Biol Sci 2012;4(5):638-42.
Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005; 172 (3), 367-79 https://doi: 10.1503/cmaj.1040752
Burke MD. Liver function: test selection and interpretation of results. Clin Lab Med. 2002 Jun;22(2):377-90. https://doi.org/10.1016/s0272-2712(01)00002-6
Johnston DE. Special considerations in interpreting liver function tests. Am Fam Physician.1999; 59: 2223-30. PMID: 10221307.
Roche SP, Kobos R. Jaundice in the Adult Patient. Am Fam Physician. 2004; 69 (2): 299-304. PMID: 14765767.
De Ritis F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. ClinChimActa. 1957 Feb;2(1):70-4. https://doi.org/10.1016/0009-8981(57)90027-x.
Arthi M, Niranjan G, Hanifah M, Srinivasan AR. EFFICACY OF DE RITIS RATIO IN DIAGNOSING LIVER DISEASES IN PUDUCHERRY POPULATION. Advance Laboratory Medicine International 2011; 1(3): 61 - 8. Corpus ID: 43209259.
Ashraf-Uz-Zaman M, Begum B, Asad H, Moutoshi S, Nasiruddin M. Biochemical Parameters in Common Viral Hepatitis. JOM 2010; 11(1): 42-5. https://doi.org/10.3329/jom.v11i1.4268.
De Ritis F, Giusti G, Piccinino F, Cacciatore L. Biochemical laboratory tests in viral hepatitis and other hepatic diseases. Bull World Health Organ 1965;32:59- 72. PMID: 14292063.
Benerji GV, Babu MF, Kumari R D, Saha A. Comparative Study of ALT, AST, GGT & Uric Acid Levels in Liver Diseases. Journal of Dental and Medical Sciences. 2013;5: 72-5. https://doi.org/10.9790/0853-0757275.
Botros M, Sikaris KA. The De Ritis ratio: the test of time. ClinBiochem Rev. 2013 Nov;34(3):117-30. PMID: 24353357.
Fortunato G, Castaldo G, Oriani G, Cerini R, Intrieri M, Molinaro E, et al. Multivariate discriminant function based on six biochemical markers in blood can predict the cirrhotic evolution of chronic hepatitis. Clin Chem. 2001; 47: 1696-700. PMID: 11514405. https://doi.org/10.1093/clinchem/47.9.1696.
Torkadi PP, Apte IC, Bhute AK. Biochemical Evaluation of Patients of Alcoholic Liver Disease and Non-alcoholic Liver Disease. Ind J ClinBiochem 2014; 29(1):79–83. https://doi.org/10.1007/s12291-013-0310-7.
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