High/Low Aspartate Aminotransferase Levels + Function & Diseases

Aspartate aminotransferase is an enzyme involved in the balance of proteins (amino acids). Levels of this molecule in the body can be used as a sign of liver disease and other health problems.

People go to their doctor to get their AST tested as part of a standard panel. Almost always, the results are not scrutinized, even though we know that you can be healthier and live longer when your results lie within optimal ranges. When I used to go to doctors and tried to discuss my results, they had no clue what these meant from a health perspective. All they cared about was whether they could diagnose me with some disease.

Read more to learn more about the function of AST, its associated diseases, and how to raise and lower levels of this molecule.

What is Aspartate Aminotransferase (AST)?

Aspartate aminotransferase (AST), also known as SGOT, is an enzyme that breaks down proteins for energy. It is found mainly in the liver and heart, but also in many other tissues, including the muscles, red blood cells, kidneys, and the brain. When any one of these tissues is damaged or diseased, AST is released into the blood [1, 2].

AST levels are often measured to check overall liver health. However, as mentioned above, increases in AST levels can also be due to damage to other organs, such as the heart, kidneys, or muscles. Therefore, AST is often paired with other tests in order to determine the specific location of the problem.

The rest of the article will elaborate on the function of this protein, how different levels of this enzyme may impact your health, and how it can serve as a marker for the disease.

Function

Aspartate aminotransferase is one of the key enzymes involved in the aspartate (amino acid) pathway. At a macro level, this pathway impacts the overall metabolism of amino acids and fats (fatty acids). The aspartate pathway also has partial roles in detoxification (urea cycle) and glucose production (gluconeogenesis) [3, 4].

At a micro level, the direct chemical reaction that aspartate aminotransferase accelerates is the conversion of an amino acid (aspartate) and acid (alpha-ketoglutarate) to a different acid (oxaloacetate) and amino acid (glutamate). This conversion is vital for other metabolic processes such as the urea cycle, glucose generation, and glucose breakdown (glycolysis) [3, 4].

Normal AST Levels

Normal healthy levels of this protein in your blood range from 5 to 40 U/L [2, 5].

There may be some lab-to-lab variability in ranges due to differences in equipment, techniques, and chemicals used.

There are a variety of health problems that are associated with higher than normal levels of AST, and this will be elaborated further below [5].

Low AST Levels

Low AST levels are expected and normal – they are just uncommon in the general population. The reference ranges are based on where 95% of the healthy population falls into, which means that there are 5% of the people who are healthy and not within the reference range!

However, in rare cases, low AST may signal vitamin B6 deficiency, because the AST enzyme requires vitamin B6 to function. Vitamin B6 deficiency is uncommon, but it’s more likely to occur in the elderly, alcoholics, and people with underlying health conditions such as liver, kidney, or inflammatory diseases [6, 7].

AST may also be low in chronic kidney disease, unrelated to vitamin B6 levels [8, 7, 9, 10].

Finally, hormone replacement therapy can decrease AST levels [11].

Increasing AST

Low values are normal and generally don’t require any action or intervention.

If you have an underlying condition that may be affecting your AST, work with your doctor to treat it!

If your vitamin B6 is on the low side:

• make sure your diet is healthy and well balanced and contains enough of all essential vitamins and nutrients, especially vitamin B6 [6]
• avoid smoking, as smoking can further decrease it [12]

Studies suggest that supplementation with vitamin B6 may help increase AST in the elderly [5].

High AST Levels

A high AST (above 40 U/L) can signal a problem with the liver, heart, or muscles.

However, a variety of factors can affect an AST result including age, diet, exercise, and the drugs and supplements a person is taking. That’s why a result that’s higher than normal, doesn’t necessarily mean that you have a health condition that needs treatment. A doctor will interpret an elevated AST result, taking into account your medical history, symptoms, and other test results.

Causes of High AST

Causes shown here are commonly associated with high AST levels. Work with your doctor or another health care professional to get an accurate diagnosis.

1) Muscle Damage

Muscle damage causes AST to leak from muscles into the blood. Muscle damage can be due to various causes, including strenuous exercise, injury, seizures, burns, or muscle diseases [13, 14, 15, 16, 17].

2) Heart Attack

Heart attack or heart failure can also result in AST leaking from the heart muscle into the blood [18, 19].

3) Liver Damage or Disease

Damage to the liver due to various liver diseases increases AST. These diseases include fatty liver, viral hepatitis, infections that affect the liver (e.g. mononucleosis), or liver cancer [20, 21].

In addition, AST also increases when there’s liver damage due to toxins such as lead, mercury, or pesticides [22, 23, 24].

There are many drugs that can increase AST by causing liver damage, but this usually only happens in a small percentage of the people taking the drug. The same applies to natural products and supplements. That’s why it’s important to tell your doctor about all of the drugs and/or supplements you are taking.

Drugs and supplements that can increase AST include:

• NSAIDs like ibuprofen (Advil) [22]
• Blood pressure medications [1]
• Opiates [25]
• Anti-seizure medications [26]
• Chemotherapy agents [27]
• Kava [28]

4) Chronic Alcohol Abuse

Chronic alcohol abuse increases AST levels [29].

5) Anorexia

Studies report that AST levels are abnormally high in over half of the people who have anorexia, mainly due to weight loss and fasting [30].

6) Pancreatitis

AST increases with severe Inflammation of the pancreas (pancreatitis) [31].

7) Gallbladder Attack

A gallbladder attack can cause both mild and short-liver sharp (up to 100 fold) increases in AST [32].

8) Abnormal Destruction of Red Blood Cells

Rupture of red blood cells (hemolysis) releases AST from blood cells [33]. There are many different conditions that can cause abnormal destruction of red blood cells, including autoimmune disease, malaria, and an enlarged spleen.

Lowering AST

The most important thing is to work with your doctor to find out what’s causing your high AST and to treat any underlying conditions. The additional lifestyle changes listed below are other things you may want to discuss with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes.

Liver Health

If your liver health is compromised:

• Over-consumption of alcohol can directly damage liver cells and worsen existing liver conditions. Avoid drinking alcohol until your AST levels return to the normal range, even if the cause is not alcohol-related [34].
• If you are overweight, losing weight may improve your liver health and help reduce AST [35].
• Some drugs or supplements can damage the liver, leading to high AST levels. Have a doctor or pharmacist review your medications to see if any of them might be causing harm to your liver [36, 37]. Discuss alternative options with your doctor.
• Research suggests that drinking moderate amounts of coffee on a regular basis may benefit liver health and lower liver enzymes in the blood, such as AST [38, 39, 40, 41, 42, 43]. Discuss your coffee intake with your doctor.

Supplements

There are a number of supplements that may reduce elevated AST levels. But it’s important to stress that these supplements most likely lower AST by improving the underlying condition. It’s always crucial to work with your doctor to treat the underlying cause of elevated AST levels. The supplements in question are as follows:

• Licorice: The effectiveness of licorice in non-alcoholic fatty liver disease (NAFLD) was evaluated in 66 patients. When supplemented with licorice for a period of 2 months, the mean AST levels significantly decreased compared to people who didn’t supplement [44].
• Green Tea: Eighty participants with NAFLD were supplemented with green tea over 12 weeks. At the end of this period, those who took green tea showed significant reductions in AST [45].
• Caffeine: A study involved 177 patients with liver disease who completed a caffeine questionnaire. This allowed researchers to evaluate the relationship between liver disease and caffeine. They found that people with greater caffeine intake had lower AST levels [46].
• Milk thistle: Supplementation with milk thistle in 34 patients with hepatitis C and 51 patients with type 2 diabetes reduced AST levels [47, 48, 49].
• Tudca (tauroursodeoxycholic acids): In a pilot study of 23 patients with liver disease, daily doses of Tudca for 6 months lowered elevated AST levels [50].

Remember, these supplements were given in small-scale trials to people with certain medical conditions (some types of liver disease) and will likely not work in people who have elevated AST due to other medical issues (such as muscle damage or red blood cell destruction). In addition, because most of these studies are low-quality clinical studies, there is insufficient evidence that these supplements would be effective in the general population.

Always consult with your physician before taking any supplements and never use a supplement as a replacement for approved medical therapies!

Animal studies have been looking at turmeric/curcumin, Ganoderma lucidum (mushroom), dill, alpha lipoic acid, N-acetyl cysteine, capsaicin, and vitamins C and E, in terms of lowering AST in liver disease [51, 52, 53, 54, 55, 56, 57, 58]. However, there is no evidence that these would have any effect in humans. We will keep you posted as new studies arise.

AST/ALT Blood Test: What Is It For and Normal Levels

AST and ALT, also known as transaminases, are two hepatic enzymes that are usually measured, through blood tests, with the purpose of assessing liver health.

AST, also known as aspartate aminotransferase is stored in the hepatic cells of the liver, but is produced in other various tissues, such as the heart and muscles. Thus, when there is only an increase in the AST levels, this is usually related to other conditions not linked to the liver.

On the other hand, ALT, known as alanine aminotransferase, is produced exclusively in the liver and therefore when there is an increase in ALT levels, it normally indicates that there may be an alteration in the liver.

Normal AST and ALT levels

AST and ALT can vary according to the laboratory, however, the levels that are considered normal are:

• AST: 5 to 40 U/L;
• ALT: 7 to 56 U/L.

Even though AST and ALT are considered liver markers, these enzymes can also be produced by other organs, especially the heart in the case of AST. Therefore, it’s important that the doctor who requested the test, checks the test results to establish a possible cause.

Possible causes for different blood levels

Alterations to both AST and ALT levels are normally indicative of liver lesion, which can happen due to hepatitis, cirrhosis, or fatty liver.

On the other hand, when only AST levels are altered, it is possibly a sign of heart disease, since AST is also a cardiac marker. In these cases, the doctor may prescribe other tests to check cardiac health, such as troponin, myoglobin and creatine phosphokinase (CPK) blood tests.

In general, alterations to both AST and ALT levels may be related to the following situations:

• Fulminant hepatitis;
• Alcoholic hepatitis;
• Cirrhosis due to excessive consumption of alcoholic drinks;
• Abusive use of illegal drugs;
• Fatty liver;
• Presence of a liver abscess;
• Acute pancreatitis;
• Bile duct obstruction;
• Heart attack;
• Heart failure;
• Cardiac ischemia;
• Muscle lesion;
• Use of medication for a long period and/or without medical supervision.

AST and ALT blood tests are normally prescribed by doctors when one of the conditions listed above is suspected or when the patient has suggestive symptoms, such as yellow skin and eyes, dark urine, frequent fatigue or yellowish to white stool.

Blood Test: Aspartate Aminotransferase (AST, or SGOT) (for Parents)

What Is a Blood Test?

A blood test is when a sample of blood is taken from the body to be tested in a lab. Doctors order blood tests to check things such as the levels of glucose, hemoglobin, or white blood cells. This can help them detect problems like a disease or medical condition. Sometimes, blood tests can help them see how well an organ (such as the liver or kidneys) is working.

What Is an AST Test?

An AST test measures the level of aspartate aminotransferase, also called AST or SGOT. AST is one of the enzymes that help the liver convert food into energy. High levels of these enzymes can be a sign that the liver is injured or irritated, and the enzymes are leaking out of the liver cells.

Why Are AST Tests Done?

An AST test may be done if a child has signs of a possible liver problem, such as jaundice (yellowish skin or eyes), dark urine, nausea, vomiting, or belly pain. It also might be done if a child is on medicine that makes high liver enzyme levels more likely.

How Should We Prepare for an AST Test?

Your child may be asked to stop eating and drinking for 8 to 12 hours before the AST test. Tell your doctor about any medicines your child takes because some drugs might affect the test results.

Wearing a T-shirt or short-sleeved shirt for the test can make things easier for your child, and you also can bring along a toy or book as a distraction.

How Is an AST Test Done?

Most blood tests take a small amount of blood from a vein. To do that, a health professional will:

• clean the skin
• put an elastic band (tourniquet) above the area to get the veins to swell with blood
• insert a needle into a vein (usually in the arm inside of the elbow or on the back of the hand)
• pull the blood sample into a vial or syringe
• take off the elastic band and remove the needle from the vein

In babies, blood draws are sometimes done as a “heel stick collection. ” After cleaning the area, the health professional will prick your baby’s heel with a tiny needle (or lancet) to collect a small sample of blood.

Collecting a sample of blood is only temporarily uncomfortable and can feel like a quick pinprick.

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Can I Stay With My Child During an AST Test?

Parents usually can stay with their child during a blood test. Encourage your child to relax and stay still because tensing muscles can make it harder to draw blood. Your child might want to look away when the needle is inserted and the blood is collected. Help your child to relax by taking slow deep breaths or singing a favorite song.

How Long Does an AST Test Take?

Most blood tests take just a few minutes. Occasionally, it can be hard to find a vein, so the health professional may need to try more than once.

What Happens After an AST Test?

The health professional will remove the elastic band and the needle and cover the area with cotton or a bandage to stop the bleeding. Afterward, there may be some mild bruising, which should go away in a few days.

When Are AST Test Results Ready?

Blood samples are processed by a machine, and it may take a few hours to a day for the results to be available. If the test results show signs of a problem, the doctor might order other tests to figure out what the problem is and how to treat it.

Are There Any Risks From AST Tests?

An AST test is a safe procedure with minimal risks. Some kids might feel faint or lightheaded from the test. A few kids and teens have a strong fear of needles. If your child is anxious, talk with the doctor before the test about ways to make the procedure easier.

A small bruise or mild soreness around the blood test site is common and can last for a few days. Get medical care for your child if the discomfort gets worse or lasts longer.

If you have questions about the AST test, speak with your doctor or the health professional doing the blood draw.

Quest – Article – Simply Stated: Elevated Enzymes

Elevated enzymes are a frequently encountered problem in general medical practice, but their meaning often isn’t so simple to discern. When they’re found with a neuromuscular disease, the situation can get complicated.

What’s an enzyme?

There are thousands of enzymes in the cells in our bodies, where they act as catalysts for all the chemical reactions that take place in these cells. Without them, these reactions either wouldn’t occur or would be too slow for the cells’ needs.

Many enzymes are normally present in the blood and can be measured there. When cells are damaged by disease or injury, large amounts of these leak out, causing blood tests to show that enzymes are elevated above normal. (You can roughly compare this situation to a car that’s leaking oil. Leaks in many parts of the engine can have the same result: oil all over your driveway.)

Where did it come from?

Measuring enzymes is only a clue to a possible diagnosis or problem, not a diagnosis in itself. An elevated enzyme level on a screening test should prompt a physician to look further into which areas of the body may be leaking enzymes into the blood, just as a good mechanic looks for the source of a car’s oil leak. (In either case, finding the source is only the first step. The next steps are finding out why the leak has occurred and attempting to fix it.)

Two enzymes often measured on routine tests are known as ALT (alanine transaminase) and AST (aspartate transaminase). ALT is found in the liver, heart, muscles and kidneys. AST is in the liver, heart, muscles, kidneys, brain, pancreas, spleen and lungs. ALT is also known as SGPT (serum glutamic-pyruvic transaminase), and AST is also called SGOT (serum glutamic-oxaloacetic transaminase).

In many neuromuscular disorders, muscle tissue is gradually damaged, either by an attack from the immune system (as in inflammatory myopathies), or by a genetic mutation inside the cells (as in the muscular dystrophies). When routine tests measuring ALT or AST are performed in people with neuromuscular disorders, these enzymes are often elevated in the blood, because the ALT and AST are leaking out of damaged muscles. But they can also leak out of other organs, particularly the liver.

Liver or muscle?

If a neuromuscular disorder hasn’t yet been diagnosed, a doctor may be misled into thinking that a damaged liver, not damaged muscles, is the source of the enzyme leak. In the general population, liver damage is more common than muscle damage, so this assumption isn’t too surprising.

The careful physician will, however, investigate further. An enzyme called GGT or gamma-GT (gamma-glutamyltransferase, also gamma-glutamyltranspeptidase) is found in the liver but not in the muscles. If it’s unclear whether the liver is damaged, a normal GGT level can help a doctor decide that it’s not, while a high GGT level would sway him or her toward thinking it is. (That’s far from the only test that can be done, but it’s an easy and relatively inexpensive one.)

CK (creatine kinase), also called CPK (creatine phosphokinase), is only found in the heart, skeletal muscles and brain. The MM form of CK is the type found in skeletal muscles, and it can be specifically measured when a doctor suspects a muscle problem. A normal CK level with elevated ALT and AST enzymes would sway a doctor toward thinking there’s a liver problem; a high CK with high ALT and AST levels suggests that something’s going on in the muscle.

So, doing additional enzyme tests after a general screen can help a doctor decide whether the high ALT and AST are more likely the result of liver or muscle damage.

Of course, there could be a problem in both liver and muscle. (Your 1982 Volvo could be leaking oil from both the oil pan and a gasket.) Some metabolic muscle disorders, such as acid maltase deficiency and debrancher enzyme deficiency, affect both tissues. And two diseases can occur in the same person.

What damages the liver?

A person at high risk for hepatitis or other liver damage, whether or not he or she has a neuromuscular disease, needs further attention focused on the liver, with the medical history and physical exam taken into account. Liver problems may occur in someone who’s had blood transfusions before 1990 (before modern hepatitis virus testing), taken drugs (prescription, over-the-counter or recreational) that are known to damage the liver, recently eaten potentially contaminated shellfish, had a history of malignancy or recently been stabbed in the abdomen — whether there’s a neuromuscular disease or not.

The medications riluzole, used to treat amyotrophic lateral sclerosis, and methotrexate, used to treat inflammatory myopathies and myasthenia gravis, are among the many drugs that have liver-damaging potential.

Most of the time, elevated ALT and AST levels in people with degenerating muscles don’t mean much, other than that these enzymes, along with CK, are leaking out of the muscles. (The high levels of enzymes do no harm in and of themselves.) But sometimes, depending on results of other tests and the person’s history, they can mean there’s trouble in the liver or even in another organ. That’s where medical detective work is needed.

“Simply Stated” is a Quest column designed to explain some terms and basic facts about neuromuscular disease.

Aspartate aminotransferase (AST) – Lab Tests Online AU

How is it used?

When is it requested?

An AST test is requested with several other tests to help evaluate a patient who has of a liver disorder. Some of these symptoms include (yellowing of the eyes and skin), dark urine, nausea, vomiting, abdominal swelling, unusual weight gain and abdominal pain. AST can also be ordered, either by itself or with other tests, for:

• persons who might have been exposed to hepatitis viruses
• those who drink too much alcohol
• persons who have a history of liver disease in their family, or
• persons taking drugs that can occasionally damage the liver.

Persons who have mild symptoms, such as tiredness, may be tested for AST to make sure they do not have long-term (chronic) liver disease. AST is sometimes measured to monitor treatment of persons with liver disease and is usually ordered along with other tests.

What does the test result mean?

Very high levels of AST (more than 10 times the highest normal level) are usually due to a rapidly developing liver disease called acute hepatitis, which is often due to a infection. In acute hepatitis, AST levels usually stay elevated for about 1–2 months, but can take as long as 3–6 months to return to normal. In the slowly developing variety of liver disease, chronic hepatitis, AST levels are usually not as high, often less than 4 times the highest normal level. In chronic hepatitis, AST often varies between normal and slightly increased, so doctors might request the test regularly to determine the pattern of change.

In some diseases of the liver, especially when the ducts are totally or partially blocked or with , AST may be close to normal. When liver damage is due to alcohol, AST often increases much more than ALT (this is a pattern seen with few other liver diseases). AST can be increased from break-up of red blood cells (haemolysis), and is increased after heart attacks and with muscle injury.

Reference Intervals

Adult

Male       5 – 35 U/L
Female   5 – 30 U/L

The reference intervals shown above are known as a harmonised reference interval. This means that eventually all laboratories in Australia will use this same interval so wherever your sample is tested, the reference interval should be the one shown above. Laboratories are in the process of adopting these harmonised intervals so it is possible that the intervals shown on the report of your results for this test may be slightly different until this change is fully adopted. More information can be found under Reference Intervals – An Overview.

Is there anything else I should know?

An injection of medicine into muscle tissue, or even strenuous exercise, may increase AST levels. In rare instances, some drugs can damage the liver or muscle, increasing AST levels. This is true of both prescription drugs and some ‘natural’ health products. If your doctor finds that you have high levels of AST, tell him or her about all the drugs and health products you are taking.

How COVID-19 affects the liver

Liver enzyme elevations are common in patients with COVID-19, Elizabeth C. Verna, MD,
MSc, said at the Liver Meeting Digital Experience’s COVID-19 and the Liver Clinical
Symposium, held last November by the American Association for the Study of Liver Diseases.

“Although they’re often mild, they may limit our therapeutic options, and it
is associated with disease severity and death,” she said. “There is
increasing evidence of a component of direct, virally mediated liver injury in these
patients, and certainly, we still have more work to do to understand the pathophysiology
of this process.”

ACE2, the receptor for the SARS-CoV-2 virus, is expressed in the liver. Autopsy findings
of people who died of COVID-19 include lobular necroinflammation and portal interface
hepatitis. Image by magicmine

There have been reports of liver enzyme elevation as a common phenomenon since the
very first published descriptions of the clinical manifestations of COVID-19 from
China. Now, the literature on the association between COVID-19 and elevated liver
tests is extensive, with several meta-analyses and systematic reviews supporting it,
said Dr. Verna, a hepatologist at Columbia University Irving Medical Center in New
York City.

“While the proportion of patients with evidence of liver injury varies by geographic
location, the definition of the upper limit of normal, the disease severity in the
cohort, and the timing of the liver enzyme measurement in the disease course, overall,
elevation in liver tests [has] been reported in 14% to 53% of inpatients with COVID-19,”
she said.

Across studies, aspartate aminotransferase (AST) is generally the most commonly elevated
value. In one meta-analysis, largely of reports from China, the pooled prevalence of liver injury was 19% in 12 studies, according to results published in the July 2020 The Lancet Gastroenterology & Hepatology. The pooled prevalence of increased AST was 21%, followed by increased alanine aminotransferase
(ALT) at 18%, increased total bilirubin at 6%, and decreased albumin at 6%.

In addition, Dr. Verna’s group found that the overall initial and peak AST and ALT levels were elevated among 2,270 patients with confirmed
COVID-19 compared to 1,108 controls who tested negative for SARS-CoV-2 but were hospitalized
during the same period, according to results published online last May by Hepatology. “But these elevations were generally mild, with the peak ALT over the upper
limit of normal in 45% [of patients with COVID-19] but over five times the upper limit
of normal in only 6%,” she noted.

Liver enzyme elevation may not be initially present in patients with COVID-19 and
may be a later manifestation of the disease, following progressive pulmonary and kidney
manifestations, Dr. Verna said. “And each individual assay in the liver function
panel may have a different trajectory, with ALT perhaps being the most reflective
of the clinical association between the virus and liver injury,” she said.

However, researchers who have evaluated predictors of liver injury in many cohorts
have found variable results overall. “In our cohort, there was not a clear
association between liver enzyme elevation (defined by ALT over five times the upper
limit of normal) and some of the traditional risk factors for severe COVID-19, including
advanced age and elevated [body mass index],” Dr. Verna said. “Rather,
there was a clear association with other inflammatory markers, including [interleukin-6]
and ferritin, even [after] controlling for these traditional risk factors, perhaps
implicating, at least in part, the host immune response in the pathogenesis of elevated
ALT in this case.”

While liver enzyme elevation in patients with COVID-19 is generally mild and does
not require a specific intervention, it may be an important prognostic marker, she
said. For example, a meta-analysis published online last August by Annals of Hepatology showed a significant association between elevated AST and elevated ALT levels and critical illness related to COVID-19.

Dr. Verna added that in data from her center, “We did find that peak ALT was
highly predictive of death or discharge to hospice [after] controlling for advanced
age, comorbidities that have been associated with COVID-19, and … markers
of critical illness, including the need for intubation or renal replacement therapy.”

The causes of liver enzyme elevation are likely multifactorial, she said. “Certainly,
underlying liver disease may play a role in a certain portion of our patients. For
those that require ICU-level care, sepsis, ischemia, and congestion are important
considerations,” said Dr. Verna, adding that nonhepatic sources are also important
to consider, particularly when AST is elevated out of proportion to other markers.
Drug-induced liver injury may be quite common as well, and both the host immune response
and direct virally mediated liver injury are also likely playing a role, she said.

In addition, ACE2, the receptor for the SARS-CoV-2 virus, is expressed in the liver
itself, Dr. Verna said. “This has been shown in a number of different studies
with different methodologies. … Probably cholangiocytes have the highest level
of expression, but there is also documented expression in hepatocytes themselves,”
she said.

There is also a growing literature on the histological changes in the liver that are
seen in patients with COVID-19, predominantly from postmortem studies, Dr. Verna noted.

“These findings do include findings typical of a virally mediated process.
In the first 40 autopsies reviewed at our center for patients that died of COVID-19,
about half of patients had lobular necroinflammation and/or portal interface hepatitis,”
she said. “In addition, we also found high rates of steatosis, as has been
reported by other groups as well, with 75% of patients overall having steatosis (many
without traditional risk factors for this) and about 30% with moderate or severe steatosis.”

Vascular findings included phlebosclerosis, endothelial injury, and sinusoidal thrombosis,
as well as thrombotic bodies that are thought to be aggregations of platelets, Dr.
Verna added.

Her research group also looked for SARS-CoV-2 in liver tissues using polymerase chain reaction (PCR) testing on 20 autopsy livers. Eleven (55%) liver specimens were positive for the virus, according
to results published online last August by Modern Pathology.

“Interestingly, although the numbers are small, there was no correlation between
a positive PCR in the liver tissue and the time from diagnosis to death or any of
the individual lab test results, although those with a positive PCR had a trend towards
higher AST and ALT [levels],” Dr. Verna said.

Patients with chronic liver disease may be at increased risk of severe COVID-19 outcomes,
particularly those with nonalcoholic-associated fatty liver disease; however, the
greatest impact may be among those with decompensated cirrhosis, she said. On the
other hand, liver transplant recipients do not seem to be at higher risk of mortality
from COVID-19 compared to the nontransplant population, said Dr. Verna.

For patients with COVID-19 and elevated serum liver biochemistries whose tests are
stable or improving, the only necessary intervention is close monitoring, whereas
those with worsening liver tests should be evaluated for other causes (e.g., myositis),
she said.

“Luckily, as liver enzyme abnormalities are often mild and resolve on their
own, minimal initial workup is currently recommended, including testing for viral
hepatitis, such as hepatitis A, B, and C,” Dr. Verna said. “Additional
workup, including imaging and other studies, is probably most likely reserved for
patients with progressive or severe liver enzyme elevation or in patients with more
of a cholestatic pattern, which would be less typical of COVID-19-related liver injury.”

Aspartate Aminotransferase (AST) Test | CS Mott Children’s Hospital

Test Overview

An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was called serum glutamic oxaloacetic transaminase (SGOT).

Low levels of AST are normally found in the blood. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage. After severe damage, AST levels rise in 6 to 10 hours and remain high for about 4 days.

The AST test may be done at the same time as a test for alanine aminotransferase, or ALT. The ratio of AST to ALT sometimes can help determine whether the liver or another organ has been damaged. Both ALT and AST levels can test for liver damage.

Why It Is Done

This test is done to:

• Check for liver damage.
• Help look for liver disease, such as hepatitis. Liver disease may cause symptoms. These may include pain in the upper belly, nausea, vomiting, and sometimes jaundice.
• Check to see how well treatment for liver disease is working.
• Find out if jaundice was caused by a blood disorder or liver disease.
• Keep track of the effects of medicines that can damage the liver.

How To Prepare

In general, there’s nothing you have to do before this test, unless your doctor tells you to.

How It Is Done

A health professional uses a needle to take a blood sample, usually from the arm.

How long the test takes

The test will take a few minutes.

Watch

How It Feels

When a blood sample is taken, you may feel nothing at all from the needle. Or you might feel a quick sting or pinch.

Risks

There is very little chance of having a problem from this test. When a blood sample is taken, a small bruise may form at the site.

Results

An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. Results are usually available within 12 hours.

Normal

The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

High values

High levels of AST may be caused by:

References

Citations

1. Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Kathleen Romito MD – Family Medicine
Jerome B. Simon MD, FRCPC, FACP – Gastroenterology

Current as of: September 23, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & Kathleen Romito MD – Family Medicine & Jerome B. Simon MD, FRCPC, FACP – Gastroenterology

Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Biochemical blood test – to pass the analysis to SZCDM

Biochemical blood test (BAC) is one of the most informative tests that gives an idea of ​​the functioning of the kidneys, liver, gallbladder, pancreas, other organs, lipid, protein and carbohydrate metabolism, and the balance of trace elements.

A LHC can be prescribed by any doctor, because with each disease it is important to see the big picture.For preventive purposes, blood biochemistry is done once a year, during pregnancy – in the 1st and 3rd trimesters with a normal course and more often – with a woman’s ailments and complaints about her well-being.

Indication for analysis:

• complaints of malaise;

• any disease;

• assessment of the state after therapy;

• preventive examination.

Studies during biochemical blood analysis

During biochemical analysis, blood sugar, urea, total lipids, low and high density cholesterol, triglycerides, total bilirubin, total protein, AsAt, AlAt enzymes, lipase, amylase, gamma-GTP and other indicators are determined.

Each of the indicators may indicate the normal functioning of an organ, system, or a deviation from the norm.

It should be remembered that blood biochemistry is a primary diagnosis, an assessment of a person’s general health. Its results can only be interpreted by an experienced specialist. According to the indicators of the LHC, the doctor prescribes special tests if there are suspicions of a disease or organ pathology.

A biochemical blood test is a large number of test items. Next, we will talk about the main ones.

Further in the text there are research norms, WHICH HAVE AN INTRODUCTORY CHARACTER.

In all laboratories, the norms, units of measurement may differ, as well as THEY DEPEND on the gender and age of the patient.

BE CAREFUL!

Specific proteins and markers of inflammation

More than 20 plasma proteins are called specific proteins and markers of inflammation, the concentration of which indicates the development of acute inflammation or tissue damage.

C-reactive protein

CRP is one of the most sensitive markers of acute inflammation and tissue damage. It appears in the blood serum and rapidly increases in volume when:

• various inflammations;

• diseases of the gastrointestinal tract;

• parasitic, viral, bacterial infections;

• systemic rheumatic diseases;

• metastases of cancerous tumors;

• tissue damage, including acute myocardial infarction;

• sepsis of newborns;

• meningitis;

• tuberculosis;

• burns;

• taking oral contraceptives, estrogens.

From the above list, it is clear that the indicator has low specificity, therefore, with its high indicators, more narrow studies are immediately prescribed if the reason for the increase is unknown.

The CRP indicator is used to determine the success of therapy: if the treatment is successful, the protein is normalized after 6-10 days

Eosinophilic cationic protein (ECP)

ECP rises when:

• atopic bronchial asthma;

• allergic rhinitis;

• atopic dermatitis;

• food allergies;

• helminthiasis;

• acute respiratory infections;

• malignant diseases with activation of eosinophils;

• taking certain medications.

Rheumatoid factor

Rheumatoid factor – proteins that are produced by the human immune system. An increase in the RF rate may indicate rheumatoid arthritis, Sjogren’s syndrome, chronic infections of a bacterial, viral, parasitic nature, some types of oncology, diseases of the kidneys, liver, and lungs.

Myoglobin

The concentration of myoglobin increases if the myocardium or skeletal muscle is damaged.Normally, its concentration is not determined in the laboratory – so little myoglobin is found in the blood of a healthy person, from 0 to 70 μg / l.

Troponin I

Tn I is a protein of the heart muscle that enters the bloodstream during myocardial infarction. It belongs to the most sensitive and specific indicator for damage to the heart muscle. After a heart attack, approximately 3 hours later, the level of Tn I in the blood rises significantly and remains so for up to 14 days.

Creatine kinase MB

KK-MB is a cell enzyme that is used as a specific and sensitive indicator of myocardial damage.

KK-MB is located almost in full in the heart muscle, therefore its content in the bloodstream is negligible. If it increases, then there is a high probability of an acute heart attack, recurrent heart attack and other pathological processes associated with the heart.

NT-proBNP

NT-proBNP is a protein of the left ventricle of the heart. A change in its level may indicate heart failure, its severity. The level of this protein is also used to assess the effectiveness of therapy for heart failure.

The norm for people under 75 years old is 0-125 pg / ml, over 75 years old – up to 450 pg / ml.

Antistreptolysin-O (ASLO)

ASLO is a marker of streptococcal infection. Its increase is caused by tonsillitis, scarlet fever, chronic tonsillitis, acute glomerulonephritis, streptococcal pyoderma.

Procalcitonin

Procalcitonin increases in the blood during bacterial infections, sepsis, septic shock, multiple organ failure and some other serious conditions.

Electrolytes

Electrolytes include chlorine, sodium, potassium. They play an important role in metabolic processes, maintain acidity and water balance. Electrolyte levels are the most important characteristic of human health, an indicator of the functionality of the heart and kidneys.

Abnormalities are caused by impaired renal function, heart disease, diabetes mellitus, pathologies and disorders in the work of muscles and the nervous system.If the electrolyte imbalance is not stabilized, eliminating its causes, the person will experience dizziness, convulsions, and irregular heart rhythms. In especially advanced cases, electrolyte imbalance leads to death.

Lipid exchange

The LHC shows the level of fat and allows you to assess the risk of occurrence, development of heart, vascular diseases. During testing, the level of triglycerides, cholesterol – total, LDL, HDL is checked.

Triglyceride level

Triglycerides grow in diabetes mellitus, cardiac and vascular pathologies, pregnancy; decrease in case of disorders in the thyroid gland, at the terminal stage of liver damage, if a person eats poorly, monotonously.

Cholesterol

• HDL (“good cholesterol”). Participates in the processing and removal of fats from the body. If the values ​​are high, the risk of vascular plaque formation decreases.The norm is 1.03-1.55 mmol / l.

• LDL (“bad cholesterol”). Normally – 0-3.3 mmol / l – it is necessary for the body. Exceeding the norm threatens the development of atherosclerosis.

• General (consists of HDL and LDL). The normal indicator is 5.2 mmol / l. Decrease against the norm leads to psychophysiological disorders, reproductive dysfunction. Elevated levels can cause diabetes mellitus, atherosclerosis.

Carbohydrate metabolism

During the LHC, the level of glucose and fructosamine is examined. An increase in their level can occur with diabetes mellitus, a decrease – with pancreatic tumors, when taking insulin.

• the norm for glucose is 3.3–5.5 mmol / l;

• the norm for fructosamine is up to 285 μmol / l.

Pigments

During the LHC, the level of bilirubin is set – total (yellow), direct, indirect.

• General. Normally – 3.4-17.1 μmol / l, an increase occurs in pathologies, liver diseases, disruption of its work.

• Straight. Normally – up to 7.9 μmol / l, an increase signals liver and biliary tract pathologies.

• Indirect. Its indicators are calculated, depend on direct and total bilirubin. An increase in indirect bilirubin is often associated with anemia, malaria.

Iron

Serum iron is one of the most important health indicators. It transports and stores oxygen, participates in hematopoiesis, is part of many proteins and enzymes. It is especially necessary to carefully monitor the level of iron in children, adolescents, pregnant and lactating women, the elderly, those who are experiencing high physical activity, suffering from chronic bleeding.

A decrease in the level of iron occurs with improper diet, profuse blood loss, non-assimilation of iron, increased need for it.

Enzymes

Liver tests

The standard set of LHC indicators includes the so-called. “Liver tests” – ASAT, ALAT.

• The norm of ASAT is up to 31 U / l in women, up to 37 U / l in men.

• The ALAT norm is up to 34 U / L in women, up to 45 U / L in men.

Changes in the norm can signal disease, liver, heart disease, inflammation and infections.

Amylase

Amylase is an enzyme in the digestive juice. An increase in its level occurs in acute, chronic pancreatitis, other diseases (including tumors) affecting the pancreas.

The rate of amylase is 28-100 U / l.

Pancreatic amylase

Pancreatic amylase – P-type amylase. An increase in the level of P-type amylase occurs when the pancreatic duct is blocked by a tumor, stone, and in some other cases.

Creatine kinase

CC is an enzyme that provides energy for muscle contraction. In the blood, it is present in different isomers. By increasing the concentration of individual isomers, an assumption is made about damage to muscles, myocardium, and oncological diseases.

Lipase

Lipase is an enzyme in the digestive juice. A change in the norm indicates problems with the pancreas.

Vitamins

The standard BAC determines the concentration of vitamin B12. It is necessary, first of all, for hematopoiesis. An increase in the level of B12 occurs in diseases of the kidneys, liver, leukemia, a decrease – in vegetarianism, inflammation of the gastrointestinal tract, parasitic infections. The norm of the vitamin is from 208 to 963.5 pg / ml.

The LHC may include a test for the content of vitamins of group D. Up to 60% of people around the world are deficient in this vitamin.Lack of vitamin is expressed in rickets (children), muscle weakness, pain in the pelvic bones, lower back, legs. With vitamin intoxication (uncontrolled intake of vitamin-containing complexes), headaches, nausea, vomiting, metallic taste in the mouth, acute pancreatitis, nephro- and arteriocalcinosis occur.

The norm for vitamin D2 is 0.8-7 ng / ml, for vitamin D3 it is 2.2-42.6 ng / ml.

Rules for preparing for analysis and delivery of the LHC

Blood counts are influenced by many factors: food (including drinking water), habits, physical and mental condition, bathing, medications, alcohol, smoking, etc.Therefore, in order to obtain accurate data, several requirements must be met:

• donate blood on an empty stomach, from 8 to 11 am (all laboratory parameters are calculated for this time, they change over the course of the day). Even water is recommended not to drink whenever possible. At least 8 hours should pass since the last meal, ideally 12 hours;

• on the eve, or better in a few days, you should give up heavy, fatty, fried foods, strong tea, alcohol, carbonated drinks, and other foods that can change the functioning of the liver, kidneys, pancreas;

• a day before the analysis, avoid physical, psychological overload, do not go to the bathhouse, solarium, do not do x-rays, fluorography, physiotherapy, ultrasound;

• refrain from taking medications a day before the analysis.If this is not possible, you need to inform the doctor and follow his recommendations;

• do not smoke 2 hours before donating blood;

• just before donating blood, sit for 15-20 minutes to calm down, stabilize breathing, pressure.

Important! The rules for donating blood for the LHC may differ in different laboratories, therefore, it is necessary to clarify them before testing.

How the study is conducted

For research, take blood from a vein.

Cost of biochemical blood test at SZDTSM JSC

In order to clarify the cost of the studies you are interested in, you need to call the call-center or familiarize yourself with the price list presented in the “Analyzes and Prices” section.

Where to take a biochemical blood test

Analyzes can be taken in any division of SZTsDM JSC, which is most conveniently located to you geographically.

And also it is possible to order a nurse’s visit to your home or office, the departure is FREE OF CHARGE, only the collection and analyzes are paid in accordance with the presented price list and with the preservation of all cumulative discounts, if any.

90,000 Pass a blood test for ALT (alanine aminotransferase) at the KDL

laboratory

Alanine aminotransferase (ALT, ALT) is an enzyme found in significant quantities in liver and kidney cells.Its lower activity is detected in the heart and muscles. The main function of ALT is to transform the amino acid alanine into pyruvate, the main product of cellular energy metabolism. When liver cells are damaged, ALT is released into the blood, the increase in the level of this enzyme in the blood outstrips such a clear sign of liver damage as jaundice.

When is ALT testing usually prescribed?

Most often, this study is prescribed for signs of liver damage. ALT and AST (also called “liver transaminases”) are considered some of the most important tests for detecting liver disease, although ALT is more liver specific than AST.Often, doctors calculate the AST / ALT ratio – the de Ritis ratio. This relationship can be used to differentiate the causes of liver damage and to recognize myocardial damage or muscle pathology.

The most commonly used combination of tests for liver disease is AST, ALT, bilirubin fractions, GGT, ALP and albumin or total protein.

What exactly is determined in the analysis process?

The activity of the ALT enzyme is determined by the method of UV kinetic determination.

What do the test results mean?

A significant increase in ALT levels is usually associated with acute viral hepatitis (there may be more than 10-fold increase) or with acute toxic liver damage with massive damage to hepatocytes.

A moderate increase in ALT (exceeding several times) is characteristic of chronic viral hepatitis, impaired outflow of bile and chronic diseases of the hepatobiliary zone, alcohol abuse, liver damage in infectious diseases.

Elevated ALT can also be a sign of acute myocardial infarction, trauma or inflammation of the skeletal muscles.

Typical Test Lead Time

Usually an ALT result can be obtained within 1-2 days

Do I need special preparation for the analysis?

No special training required. You can read more about the terms of delivery in the section “Preparation”

Biochemical blood test

– it is a negative ion, which in the blood is bound to the positive sodium ion, and also performs its own special functions.

What do the ALT test results mean?

AsAt is a cellular enzyme, the ratio of the content of which to the concentration of AlAt makes it possible to reveal the presence of serious diseases of the heart, liver and muscles.

Where to take the analysis?

Save money on medical examinations by becoming a member of a special discount program.

Learn more …

Blood test is the first diagnostic procedure that is prescribed to a patient in order to identify the cause of ailment. In addition to the general biochemical analysis, there are dozens of more narrowly focused types of laboratory diagnostics, and one of them is the ALAT test, which is performed to detect liver diseases.

Why donate blood for AlAt analysis?

AlAt (or ALT) is the abbreviated name for the enzyme alanine aminotransferase. It is found primarily in liver and kidney cells. It is found in small amounts in the heart and muscles. When liver cells are damaged, even at the earliest stages of the disease, AlAt enters the bloodstream. An increase in the level of AlAt allows you to determine that not everything is in order with the liver, long before the manifestation of other symptoms of the disease – for example, hepatitis.That is why the activity of alanine aminotransferase can give very accurate information about the state of the liver and make a diagnosis in time.

Most often, the AlAt analysis is prescribed to check the condition of the liver in hepatitis, as well as when taking medications that can have a negative effect on this organ. This analysis can clarify the clinical picture in other toxic and infectious liver diseases. It should be noted that sometimes the activity of alanine aminotransferase increases in diseases of other organs.

AlAt analysis is often prescribed for symptoms characteristic of liver damage: chronic fatigue and loss of strength, loss of appetite, systematic nausea and vomiting, abdominal pain, jaundice, itching.

Sometimes this study is prescribed for people who do not have obvious signs of liver disease, but their health and lifestyle increase the risk of developing liver pathologies. The risk group includes people who have previously had hepatitis or have recently been in contact with other patients, suffering from obesity or diabetes, drinkers, people taking a large amount of drugs, and those who have a genetic predisposition to liver disease.The test is also done regularly during the course of treatment for liver disease to check the effectiveness of the therapy.

Often, an analysis for ALT is prescribed together with an analysis for the content of another enzyme – aspartate aminotransferase (AsAt). The ratio of AlAt and AsAt can tell a lot about the severity and nature of liver damage.

Usually, a referral for this type of research is given by a therapist, gastroenterologist, infectious disease specialist, hematologist, endocrinologist or surgeon.

How to prepare for the procedure?

Several factors affect the accuracy of test results – a change in the level of alanine aminotransferase can cause some foods, stress, some drugs, exercise.In order for the data to be as accurate as possible, simple rules should be followed before taking analyzes. Blood is taken on an empty stomach, at least 12 hours after the last meal. Immediately before the analysis, you should spend 30-40 minutes in complete rest, excluding physical and emotional stress. Finally, smoking is not recommended on the day of analysis.

Important!
Not only medications can damage the liver, but also harmless – as many believe – dietary supplements.Some of them cause an increase in the level of AlAt. That is why it is necessary to tell your doctor not only about all medications taken, but about dietary supplements and vitamin complexes.

Interpretation of the results of the analysis for AlAt

Norm

In healthy people, the activity of AlAt in the blood is very low. Normally, the level of AlAt in the blood in children under six months is less than 60 U / L, under one year old – less than 54 U / L, under six years old – less than 30 U / L, up to 12 years old – less than 38 U / L.In healthy boys under 18 years old, this indicator does not exceed 27 U / L, in girls under 18 years old – 24 U / L. For adult men, the normal ALT value in the blood is less than 41 U / L, for adult women – less than 31 U / L.

By the way
Despite the fact that the norm of the AlAt content in the blood in women is 31 U / L, in the first trimester of pregnancy a slight increase in the level of this enzyme is possible. As a rule, this is not considered a deviation and does not indicate the development of pathology.

Reasons for increased ALT activity

Elevated ALT may indicate the presence of serious liver diseases: viral hepatitis, toxic liver damage, cirrhosis, primary or metastatic liver cancer. It is also characteristic of fatty hepatosis and pancreatitis. The increase in the content of AlAt in the blood test is directly proportional to the severity of the disease. In some cases, this figure may exceed the norm by 50, or even 100 times. In acute viral infections, the level of this enzyme is very high, while in chronic hepatitis it can exceed the norm by only 4 times.An increase in the content of alanine aminotransferase by 5-10 times is very typical for carcinoma, and in cirrhosis of the liver, the level of ALT is about 5 times higher than the normal value.

Sometimes high ALT may not be directly related to liver disease. An increase in indicators is observed with hypoxia and shock, myocarditis, extensive myocardial infarction, myodystrophy, myositis, heart failure. In addition, a high level of ALT is typical for people who have received severe burns, for chronic alcoholics, people taking hepatotoxic drugs (these include immunosuppressants, antibiotics, anabolic steroids, some psychotropic drugs, antineoplastic drugs, oral contraceptives, sulfa drugs and salicylates).

In some cases, an increase in the level of AlAt is not associated with pathologies at all. In people who are intensively involved in sports or hard physical labor, as well as fans of fast food (and any fatty food), the level of alanine aminotransferase often exceeds normal – however, not much.

Reasons for a decrease in the concentration of the enzyme in the blood

A low level of AlAt is also an alarming symptom. A decrease in the content of this enzyme in the blood is often a sign of severe liver damage, accompanied by a decrease in the number of cells that produce alanine aminotransferase.Such diseases include necrosis and cirrhosis of the liver. But everything is not so scary – sometimes the level of ALT decreases due to a lack of vitamin B6 in the body.

Biochemical blood test to determine the level of hepatic enzymes, indications for analysis, indicators

Due to the relatively small number of nerve endings in the tissues, the liver practically does not give a pain response to the body, and the diseases are almost asymptomatic. To detect liver dysfunction, a biochemical blood test is used to determine the level of liver enzymes.It allows you to identify an anomaly before the first signs appear.

Indications for analysis

Liver examination is recommended for prophylactic purposes. Also, diagnostics is necessary for certain people, for example, those who have undergone surgery, which may affect the functioning of the organ, pregnant women, as well as people with an existing disease that is chronic in nature. A number of symptoms that cannot be ignored can signal an immediate examination of the liver using a biochemical blood test.

Increased liver size . Organ enlargement is accurately detected by ultrasound examination. The symptom for self-determination of this anomaly is an enlarged abdomen without weight gain.

Unpleasant aftertaste . Often, liver disease is accompanied by a bitter taste and dry mouth. The perception of taste may change, and the usual food can cause the feeling of the presence of copper in the mouth and provoke nausea up to gagging.

Weight loss . This symptom is mainly the result of refusal to eat. There may be increased irritability, weakness due to insufficient energy, even for daily activities.

Pain or discomfort in the hypochondrium on the right . A person may feel constriction in this area, pulling pain, tingling, which intensify with sudden movements, the use of certain foods.

Jaundice .The yellowness of the skin, mucous membranes, and also the whites of the eyes indicates an excess of the level of bilirubin, which is a clear symptom of liver disease.

Analysis indicators

Decryption is done by a doctor who can identify liver pathology by analyzing all the data together. Some of the main indicators of liver function are:

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Veterinary biochemical blood test, Dnipropetrovsk, Dnipro