What is the typical AST:ALT ratio in alcoholic liver disease?

In alcoholic liver disease, the typical AST:ALT ratio is approximately 2:1. This distinctive elevation of aspartate aminotransferase (AST) relative to alanine aminotransferase (ALT) is due to the manner in which alcohol affects liver enzymes.

AST is found in higher concentrations in the liver, heart, and muscle, whereas ALT is predominantly found in the liver. In the context of alcohol-related liver injury, AST tends to rise more significantly compared to ALT primarily because of the mitochondrial damage caused by alcohol metabolism, which preferentially affects AST levels. The 2:1 ratio helps to differentiate alcoholic liver disease from other causes of liver injury, where typically, ALT is equal to or sometimes higher than AST.

Recognizing this ratio can assist clinicians in quickly identifying potential alcohol-related liver issues and guiding further diagnostic and therapeutic approaches. Understanding these enzyme levels is crucial for the accurate interpretation of liver function tests in patients suspected of having liver disease related to alcohol use.